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Use
of Genotypic Resistance Testing to Guide HIV Therapy: Clinical Impact
and Cost-Effectiveness [Weinstein MC, et al. Ann Intern
Med 2001;134:440]: The
authors address the issues of cost-effectiveness of genotypic resistance
testing for patients with HIV infection. The analysis was based
on published data on GART and was stratified by CD4 cell count.
The results of this analysis suggest that resistance testing increased
life expectancy by three months at a cost of $17,900/QALY gained.
This testing was judged cost-effective even if the cost of testing
was $10,000/year.
Comment:
There are some important assumptions here, perhaps the most important
being that GART is valid. The recent study from California, which
is not yet published (but has been announced to the press), showed
no benefit with resistance testing compared to expert advice based
on drug history. Thus, there will be some debate about the validity
of these results in cost analysis resulting in variations in results
of resistance testing. This aside, there now seems to be a plethora
of studies of interventions for HIV infection, which have convincingly
shown cost-effectiveness of OI prophylaxis and HAART, and possibly
resistance testing as well. What HIV care providers now need is
cost-analysis of novel methods to improve adherence.
posted
3/23/2001
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