Evidence map›Paper›PMID 24129369›Full record

ArticleJournal of acquired immune deficiency syndromes (1999)2013

Cost-effectiveness of newer antiretroviral drugs in treatment-experienced patients with multidrug-resistant HIV disease.

Ahmed M Bayoumi, Paul G Barnett, Vilija R Joyce, Susan C Griffin, Huiying Sun, Nick J Bansback, Mark Holodniy, Gillian Sanders, Sheldon T Brown, Tassos C Kyriakides and 5 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of acquired immune deficiency syndromes (1999), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
0.5field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Article
  4. Review
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  6. Article
  7. The Cost-Effectiveness of Financial Incentives for Viral Suppression: HPTN 065 Study.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2019
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 11 institutions in 3 countries.

Ahmed M Bayoumi*Center for Research on Inner City Health, The Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; †Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ‡Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; §Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; ‖VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, CA; ¶Center for Health Economics, University of York, York, United Kingdom; #Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada **CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada; ††School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; ‡‡VA Palo Alto Health Care System, Palo Alto, CA; §§Department of Medicine, Stanford University, Stanford, CA; ‖‖Duke Clinical Research Institute, Duke University, Durham, NC; ¶¶James J. Peters VA Medical Center, Bronx, NY; ##Department of Medicine, Mt. Sinai School of Medicine, New York, NY; ***VA Cooperative Studies Program Coordinating Center, West Haven, CT; †††MRC Clinical Trials Unit, London, United Kingdom; ‡‡‡Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; §§§The University of Ottawa at The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and ‖‖‖Center for Primary Care and Outcomes Research and Center for Health Policy, Stanford University, Stanford, CA.
Paul G Barnett
Vilija R Joyce
Susan C Griffin
Huiying Sun
Nick J Bansback
Mark Holodniy
Gillian Sanders
Sheldon T Brown
Tassos C Kyriakides
Brian Angus
D William Cameron
Aslam H Anis
Mark Sculpher
Douglas K Owens
Stanford University · USVA Palo Alto Health Care System · USDuke University · USHIV Legal Network · CAJames J. Peters VA Medical Center · USMRC Clinical Trials Unit at UCL · GBOttawa Hospital Research InstituteProgram Support Center · USSt. Paul's Hospital · CAUniversity of British Columbia · CAUniversity of Toronto · CA

Funding

Making Better Decisions: Policy Modeling for AIDS and Drug AbuseR01DA015612 · NIDA · STANFORD UNIVERSITY · PI OWENS, DOUGLAS K · 2002 to 2017
$9.4M
Comparative effectiveness of ART for HIV in patients with comorbiditiesRC1AI086927 · NIAID · STANFORD UNIVERSITY · PI OWENS, DOUGLAS K · 2009 to 2010
$972k
CIHRNIAID NIH HHS 1RC1AI086927-01NIAID NIH HHS RC1 AI086927NIDA NIH HHS 2 R01 DA15612-016NIDA NIH HHS R01 DA015612
6 · The paper itself

Abstract

objectiveNewer antiretroviral drugs provide substantial benefits but are expensive. The cost-effectiveness of using antiretroviral drugs in combination for patients with multidrug-resistant HIV disease was determined.

designA cohort state-transition model was built representing treatment-experienced patients with low CD4 counts, high viral load levels, and multidrug-resistant virus. The effectiveness of newer drugs (those approved in 2005 or later) was estimated from published randomized trials. Other parameters were estimated from a randomized trial and from the literature. The model had a lifetime time horizon and used the perspective of an ideal insurer in the United States. The interventions were combination antiretroviral therapy, consisting of 2 newer drugs and 1 conventional drug, compared with 3 conventional drugs. Outcome measures were life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness.

resultsSubstituting newer antiretroviral drugs increased expected survival by 3.9 years in advanced HIV disease. The incremental cost-effectiveness ratio of newer, compared with conventional, antiretroviral drugs was $75,556/QALY gained. Sensitivity analyses showed that substituting only one newer antiretroviral drug cost $54,559 to $68,732/QALY, depending on assumptions about efficacy. Substituting 3 newer drugs cost $105,956 to $117,477/QALY. Cost-effectiveness ratios were higher if conventional drugs were not discontinued.

conclusionsIn treatment-experienced patients with advanced HIV disease, use of newer antiretroviral agents can be cost-effective, given a cost-effectiveness threshold in the range of $50,000 to $75,000 per QALY gained. Newer antiretroviral agents should be used in carefully selected patients for whom less expensive options are clearly inferior.

Indexed as

Anti-HIV AgentsCD4 Lymphocyte CountCohort StudiesDrug Resistance, Multiple, ViralHIV-1HIV InfectionsHumansModels, BiologicalQuality-Adjusted Life YearsViral LoadAnti-HIV Agents

Identifiers

PMID24129369
PMCPMC3932156
OpenAlexW2004873336

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.