Cost of Resistance Testing in HIV Treatment in South Africa
Author Information
Author(s): Sydney Rosen, Lawrence Long, Ian Sanne, Wendy S. Stevens, Matthew P. Fox
Primary Institution: Center for Global Health & Development, Boston University
Hypothesis
Resistance testing for patients with detectable viral loads could prove to be cost-neutral or even cost-saving for the South African treatment programme if patients who do not have resistance are maintained on first-line drugs.
Conclusion
Incorporating resistance testing into treatment guidelines in South Africa is potentially cost-neutral and can identify other reasons for failure, conserve treatment options, and generate information about emerging resistance patterns.
Supporting Evidence
- Virological failure rates over five years were 19.8% in routine maintenance and 20.2% in resistance testing.
- 16.8% of failures in resistance testing did not have any resistance mutations, resulting in fewer patients switching to second-line ART.
- The total average cost per patient over five years was $2780 in routine maintenance and $2775 in resistance testing.
Takeaway
This study looks at whether testing for drug resistance in HIV patients can save money by keeping some patients on cheaper first-line drugs instead of switching them to more expensive second-line drugs.
Methodology
A Markov model was used to estimate the cost of three treatment strategies over five years based on primary data from a large HIV treatment cohort.
Potential Biases
Estimates of non-resistance rates are based on small patient numbers and may not be representative.
Limitations
The study is based on data from a single treatment site, which may not be representative of all sites in South Africa, and does not account for mortality and loss to follow-up.
Participant Demographics
Data from approximately 10,000 adult ART patients at a public sector clinic in Johannesburg.
Digital Object Identifier (DOI)
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