Evidence map›Paper›PMID 25396263›Full record

Trial reportAIDS (London, England)2015

Opportunities for improving the efficiency of paediatric HIV treatment programmes.

Paul A Revill, Simon Walker, Travor Mabugu, Kusum J Nathoo, Peter Mugyenyi, Adeodata Kekitinwa, Paula Munderi, Mutsawashe Bwakura-Dangarembizi, Victor Musiime, Sabrina Bakeera-Kitaka and 4 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in AIDS (London, England), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Evidence Gaps in Economic Evaluations of HIV Interventions Targeting Young People: A Systematic Review.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2024
    Pooled it
  2. Trial
  3. Article
  4. Review
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

14 authors.

Paul A RevillaCentre for Health Economics, University of York, York, UK bClinical Research Centre, University of Zimbabwe cUniversity of Zimbabwe, College of Health Sciences, Harare, Zimbabwe dJoint Clinical Research Centre, Kampala ePaediatric Infectious Diseases Clinic/Baylor - Uganda, Mulago Hospital, Mulago fMedical Research Council/Uganda Research Unit on AIDS, Uganda Virus Research Institute, Entebbe, Uganda gMedical Research Council (MRC) Clinical Trials Unit at University College London, London, UK.
Simon Walker
Travor Mabugu
Kusum J Nathoo
Peter Mugyenyi
Adeodata Kekitinwa
Paula Munderi
Mutsawashe Bwakura-Dangarembizi
Victor Musiime
Sabrina Bakeera-Kitaka
Patricia Nahirya-Ntege
A Sarah Walker
Mark J Sculpher
Diana M Gibb

Funding

Medical Research Council MC_EX_G0300400Medical Research Council MC_UU_12023/26
6 · The paper itself

Abstract

objectivesTo conduct two economic analyses addressing whether to: routinely monitor HIV-infected children on antiretroviral therapy (ART) clinically or with laboratory tests; continue or stop cotrimoxazole prophylaxis when children become stabilized on ART. DESIGN AND

methodsThe ARROW randomized trial investigated alternative strategies to deliver paediatric ART and cotrimoxazole prophylaxis in 1206 Ugandan/Zimbabwean children. Incremental cost-effectiveness and value of implementation analyses were undertaken. Scenario analyses investigated whether laboratory monitoring (CD4 tests for efficacy monitoring; haematology/biochemistry for toxicity) could be tailored and targeted to be delivered cost-effectively. Cotrimoxazole use was examined in malaria-endemic and non-endemic settings.

resultsUsing all trial data, clinical monitoring delivered similar health outcomes to routine laboratory monitoring, but at a reduced cost, so was cost-effective. Continuing cotrimoxazole improved health outcomes at reduced costs. Restricting routine CD4 monitoring to after 52 weeks following ART initiation and removing toxicity testing was associated with an incremental cost-effectiveness ratio of $6084 per quality-adjusted life-year (QALY) across all age groups, but was much lower for older children (12+ years at initiation; incremental cost-effectiveness ratio = $769/QALY). Committing resources to improve cotrimoxazole implementation appears cost-effective. A healthcare system that could pay $600/QALY should be willing to spend up to $12.0 per patient-year to ensure continued provision of cotrimoxazole.

conclusionClinically driven monitoring of ART is cost-effective in most circumstances. Routine laboratory monitoring is generally not cost-effective at current prices, except possibly CD4 testing amongst adolescents initiating ART. Committing resources to ensure continued provision of cotrimoxazole in health facilities is more likely to represent an efficient use of resources.

Indexed as

Health Care CostsAntiretroviral Therapy, Highly ActiveCD4 Lymphocyte CountChildChild, PreschoolCost-Benefit AnalysisFemaleHIV InfectionsHumansMaleQuality-Adjusted Life YearsTreatment OutcomeTrimethoprim, Sulfamethoxazole Drug CombinationUgandaZimbabweTrimethoprim, Sulfamethoxazole Drug Combination

Identifiers

PMID25396263
PMCPMC4318642

What OpenQuestion holds

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LicenceCC BY-NC-ND
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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.