ArticleAIDS (London, England)2012
Genotype assays and third-line ART in resource-limited settings: a simulation and cost-effectiveness analysis of a planned clinical trial.
Article in AIDS (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Accounting for Capacity Constraints in Economic Evaluations of Precision Medicine: A Systematic Review.PharmacoEconomics · 2019Pooled it
- Antiretroviral resistance testing in HIV-positive people.The Cochrane database of systematic reviews · 2018Pooled it
- Third-line antiretroviral therapy in low-income and middle-income countries (ACTG A5288): a prospective strategy study.The lancet. HIV · 2019Trial
- Using simulation modeling to inform intervention and implementation selection in a rapid stakeholder-engaged hybrid effectiveness-implementation randomized trial.Implementation science communications · 2024Article
- Virologic re-suppression and the associated factors among children aged 1-9 years on Antiretroviral Therapy in The Aids Support Organization Soroti Region, Uganda: a retrospective cohort analysis.African health sciences · 2024Article
- Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific.HIV medicine · 2021Article
- Diverse Human Immunodeficiency Virus-1 Drug Resistance Profiles at Screening for ACTG A5288: A Study of People Experiencing Virologic Failure on Second-line Antiretroviral Therapy in Resource-limited Settings.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Discordance between Etravirine Phenotype and Genotype-Based Predicted Phenotype for Subtype C HIV-1 from First-Line Antiretroviral Therapy Failures in South Africa.Antimicrobial agents and chemotherapy · 2020Article
- Zimbabwe's national third-line antiretroviral therapy program: Cohort description and treatment outcomes.PloS one · 2020Article
- Successful establishment of third-line antiretroviral therapy in Malawi: lessons learned.Public health action · 2019Article
- Third-Line Antiretroviral Therapy Program in the South African Public Sector: Cohort Description and Virological Outcomes.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- HIV-1 second-line failure and drug resistance at high-level and low-level viremia in Western Kenya.AIDS (London, England) · 2018Article
- HIV-1 Drug Resistance and Third-Line Therapy Outcomes in Patients Failing Second-Line Therapy in Zimbabwe.Open forum infectious diseases · 2018Article
- A cross-sectional study to evaluate second line virological failure and elevated bilirubin as a surrogate for adherence to atazanavir/ritonavir in two urban HIV clinics in Lilongwe, Malawi.BMC infectious diseases · 2017Article
- Authors' Reply: Is Genotype Testing Really Cost-Effective for Primary Resistance in Brazil?Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Phenotype, Genotype, and Drug Resistance in Subtype C HIV-1 Infection.The Journal of infectious diseases · 2016Article
- Prioritizing HIV comparative effectiveness trials based on value of information: generic versus brand-name ART in the US.HIV clinical trials · 2015Article
- Association of first-line and second-line antiretroviral therapy adherence.Open forum infectious diseases · 2014Article
- Clinical impact and cost-effectiveness of making third-line antiretroviral therapy available in sub-Saharan Africa: a model-based analysis in Côte d'Ivoire.Journal of acquired immune deficiency syndromes (1999) · 2014Article
- Emergence of HIV drug resistance during first- and second-line antiretroviral therapy in resource-limited settings.The Journal of infectious diseases · 2013Review
Corrections and comments
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Authors and funding
14 authors.
Funding
Abstract
objectivesTo project the clinical and economic outcomes of a genotype assay for selection of third-line antiretroviral therapy (ART) in resource-limited settings, as per the planned international A5288 trial (MULTI-OCTAVE).
methodsWe used the Cost-effectiveness of Preventing AIDS Complications (CEPAC)-International Model to compare three strategies for patients who have failed second-line ART in South Africa: sustained second-line: no genotype assay, all patients remain on second-line ART; A5288: genotype to determine the resistance profile and assign an appropriate regimen; or population-based third-line: no genotype, all patients switch to a potent third-line regimen. Model inputs are from published data in South Africa. Resistance profiles, ART regimens, and efficacy data were those used for trial planning.
resultsProjected life expectancy for sustained second-line, A5288, and population-based third-line are 61.1, 103.8, and 104.2 months. Compared to sustained second-line ($12 ,460), per person lifetime costs increase for the A5288 ($39, 250) and population-based ($44, 120) strategies. The incremental cost-effectiveness ratio of A5288, compared to sustained second-line, is $7500/year of life saved (YLS), and for population-based third-line, compared to A5288, is $154 ,500/YLS. In the A5288 strategy, very late presentation to care, coupled with lengthy delays to obtain the genotype, dramatically reduces 5-year survival, making the population-based third-line strategy more attractive.
conclusionsWe project that, whereas the public health approach to third-line therapy is unaffordable, genotype assays and third-line ART in resource-limited settings will increase survival and be cost-effective compared to the population-based approach, supporting the value of an efficacy study.
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