Point-of-care CD4 testing to inform selection of antiretroviral medications in south african antenatal clinics: a cost-effectiveness analysis
Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays....
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| Veröffentlicht in: | PloS one 2015-03, Vol.10 (3), p.e0117751 |
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| creator | Ciaranello, Andrea L Myer, Landon Kelly, Kathleen Christensen, Sarah Daskilewicz, Kristen Doherty, Katie Bekker, Linda-Gail Hou, Taige Wood, Robin Francke, Jordan A Wools-Kaloustian, Kara Freedberg, Kenneth A Walensky, Rochelle P |
| description | Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays.
We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved).
In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs.
In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection. |
| doi_str_mv | 10.1371/journal.pone.0117751 |
| format | Article |
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We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved).
In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs.
In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0117751</identifier><identifier>PMID: 25756498</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adult ; Age ; AIDS ; Analysis ; Anti-HIV Agents - economics ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Assaying ; Care and treatment ; CD4 antigen ; CD4 Lymphocyte Count - economics ; CD4 Lymphocyte Count - methods ; Child ; Computer simulation ; Cost analysis ; Cost engineering ; Cost-Benefit Analysis ; Costs ; Disease transmission ; Economic aspects ; Female ; Gestational age ; Health aspects ; Health care ; Health Care Costs ; Highly active antiretroviral therapy ; HIV ; HIV infections ; HIV Infections - diagnosis ; HIV Infections - drug therapy ; HIV Infections - economics ; HIV Infections - transmission ; Human immunodeficiency virus ; Humans ; Infant ; Infants ; Infections ; Infectious Disease Transmission, Vertical - prevention & control ; Life Expectancy ; Life span ; Point-of-Care Systems - economics ; Pregnancy ; Prevention ; South Africa ; Tutu, Desmond ; Weaning ; Womens health ; Young Adult ; Zidovudine ; Zidovudine - economics ; Zidovudine - therapeutic use</subject><ispartof>PloS one, 2015-03, Vol.10 (3), p.e0117751</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Ciaranello et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Ciaranello et al 2015 Ciaranello et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-c8cb5b8d0b9d36bc824644d714cf8e93fa340d9ce4e46441fd6338b5c37b140e3</citedby><cites>FETCH-LOGICAL-c692t-c8cb5b8d0b9d36bc824644d714cf8e93fa340d9ce4e46441fd6338b5c37b140e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355621/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355621/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25756498$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Jhaveri, Ravi</contributor><creatorcontrib>Ciaranello, Andrea L</creatorcontrib><creatorcontrib>Myer, Landon</creatorcontrib><creatorcontrib>Kelly, Kathleen</creatorcontrib><creatorcontrib>Christensen, Sarah</creatorcontrib><creatorcontrib>Daskilewicz, Kristen</creatorcontrib><creatorcontrib>Doherty, Katie</creatorcontrib><creatorcontrib>Bekker, Linda-Gail</creatorcontrib><creatorcontrib>Hou, Taige</creatorcontrib><creatorcontrib>Wood, Robin</creatorcontrib><creatorcontrib>Francke, Jordan A</creatorcontrib><creatorcontrib>Wools-Kaloustian, Kara</creatorcontrib><creatorcontrib>Freedberg, Kenneth A</creatorcontrib><creatorcontrib>Walensky, Rochelle P</creatorcontrib><title>Point-of-care CD4 testing to inform selection of antiretroviral medications in south african antenatal clinics: a cost-effectiveness analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays.
We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved).
In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs.
In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adult</subject><subject>Age</subject><subject>AIDS</subject><subject>Analysis</subject><subject>Anti-HIV Agents - economics</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Assaying</subject><subject>Care and treatment</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count - economics</subject><subject>CD4 Lymphocyte Count - methods</subject><subject>Child</subject><subject>Computer simulation</subject><subject>Cost analysis</subject><subject>Cost engineering</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>Disease transmission</subject><subject>Economic aspects</subject><subject>Female</subject><subject>Gestational age</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Health Care Costs</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - diagnosis</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - economics</subject><subject>HIV Infections - transmission</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infant</subject><subject>Infants</subject><subject>Infections</subject><subject>Infectious Disease Transmission, Vertical - prevention & control</subject><subject>Life Expectancy</subject><subject>Life span</subject><subject>Point-of-Care Systems - economics</subject><subject>Pregnancy</subject><subject>Prevention</subject><subject>South Africa</subject><subject>Tutu, Desmond</subject><subject>Weaning</subject><subject>Womens 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Landon</au><au>Kelly, Kathleen</au><au>Christensen, Sarah</au><au>Daskilewicz, Kristen</au><au>Doherty, Katie</au><au>Bekker, Linda-Gail</au><au>Hou, Taige</au><au>Wood, Robin</au><au>Francke, Jordan A</au><au>Wools-Kaloustian, Kara</au><au>Freedberg, Kenneth A</au><au>Walensky, Rochelle P</au><au>Jhaveri, Ravi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Point-of-care CD4 testing to inform selection of antiretroviral medications in south african antenatal clinics: a cost-effectiveness analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-03-10</date><risdate>2015</risdate><volume>10</volume><issue>3</issue><spage>e0117751</spage><pages>e0117751-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays.
We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved).
In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs.
In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25756498</pmid><doi>10.1371/journal.pone.0117751</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-03, Vol.10 (3), p.e0117751 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1661987452 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acquired immune deficiency syndrome Adult Age AIDS Analysis Anti-HIV Agents - economics Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Assaying Care and treatment CD4 antigen CD4 Lymphocyte Count - economics CD4 Lymphocyte Count - methods Child Computer simulation Cost analysis Cost engineering Cost-Benefit Analysis Costs Disease transmission Economic aspects Female Gestational age Health aspects Health care Health Care Costs Highly active antiretroviral therapy HIV HIV infections HIV Infections - diagnosis HIV Infections - drug therapy HIV Infections - economics HIV Infections - transmission Human immunodeficiency virus Humans Infant Infants Infections Infectious Disease Transmission, Vertical - prevention & control Life Expectancy Life span Point-of-Care Systems - economics Pregnancy Prevention South Africa Tutu, Desmond Weaning Womens health Young Adult Zidovudine Zidovudine - economics Zidovudine - therapeutic use |
| title | Point-of-care CD4 testing to inform selection of antiretroviral medications in south african antenatal clinics: a cost-effectiveness analysis |
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