Non-Environmental Cost-Benefit News

Link: http://www.hsph.harvard.edu/press/releases/press11242003.html

The effectiveness of antiretroviral therapy for HIV infection depends on how well patients adhere to complicated drug regimens. A team of researchers led by Sue Goldie of the Harvard Center for Risk Analysis at the Harvard School of Public Health, has developed a computer model to predict whether interventions ranging from inexpensive beepers and electronic reminders to expensive, clinic-based supervised therapy would improve adherence to AIDS drug regimens and prolong life at a reasonable cost by reducing treatment failures.


The researchers found that among patients with lower levels of adherence to their medication regimen, even very expensive, moderately effective adherence interventions are likely to offer cost-effective benefits that compare favorably with other interventions in HIV disease. The study appears in the current edition of the American Journal of Medicine.


The study modeled three types of HIV-infected patients: early-stage-disease patients enrolled in clinical trials, late-stage patients also enrolled in trials, and an urban group with intermediate-stage disease not enrolled in clinical trials. The model considered a variety of treatment regimens and outcomes, several strategies to improve adherence (including direct patient supervision in a clinical or home setting, electronic beepers, alarms, or pagers, and automated medicine dispensers), and additional data from public sources to estimate costs per QALY (Quality Adjusted Life Year) as projected treatment failures were reduced.


Writing in the article, Dr. Goldie states, “Our objective was to explore the associations among the effectiveness of interventions to improve adherence, the monthly cost of such interventions, and the long-term implications of improvements in measurable intermediate outcomes such as HIV RNA suppression.”


Dr. Goldie continues, “There is no consensus that defines the cost per QALY that represents acceptable value for money. However, cost-effectiveness ratios are often placed in context by comparisons with common health interventions, such as screening for colorectal cancer, hemodialysis, and cholesterol-lowering drugs for men with cardiovascular risk factors. Interventions costing less than a commonly suggested threshold of $50,000 per QALY are often considered reasonable value for money.”


Using this threshold, the researchers found that for patients with early-stage disease, interventions of $500 per month were cost-effective, while for intermediate and even late-stage patients, even more costly ($1000 per month) interventions could still result in favorable cost-effectiveness ratios.


The research team included Milton C. Weinstein, Ph.D., Kenneth A. Freedberg, MD, MSc., of the Harvard School of Public Health, along with members from the Yale University School of Medicine, Boston University School of Public Health, the Massachusetts General Hospital and Brigham and Women’s Hospital.


For further information contact: David Ropeik Harvard Center for Risk Analysis 617.432.6011 dropeik@hsph.harvard.edu