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Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa

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Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa. / Phillips, Andrew N.; Cambiano, Valentina; Nakagawa, Fumiyo; Bansi-Matharu, Loveleen; Sow, Papa Salif; Ehrenkranz, Peter; Ford, Deborah; Mugurungi, Owen; Apollo, Tsitsi; Murungu, Joseph; Bangsberg, David R.; Revill, Paul.

In: PLoS ONE, Vol. 11, No. 12, e0167654, 15.12.2016, p. 1-20.

Research output: Contribution to journalArticle

Harvard

Phillips, AN, Cambiano, V, Nakagawa, F, Bansi-Matharu, L, Sow, PS, Ehrenkranz, P, Ford, D, Mugurungi, O, Apollo, T, Murungu, J, Bangsberg, DR & Revill, P 2016, 'Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa', PLoS ONE, vol. 11, no. 12, e0167654, pp. 1-20. https://doi.org/10.1371/journal.pone.0167654

APA

Phillips, A. N., Cambiano, V., Nakagawa, F., Bansi-Matharu, L., Sow, P. S., Ehrenkranz, P., ... Revill, P. (2016). Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa. PLoS ONE, 11(12), 1-20. [e0167654]. https://doi.org/10.1371/journal.pone.0167654

Vancouver

Phillips AN, Cambiano V, Nakagawa F, Bansi-Matharu L, Sow PS, Ehrenkranz P et al. Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa. PLoS ONE. 2016 Dec 15;11(12):1-20. e0167654. https://doi.org/10.1371/journal.pone.0167654

Author

Phillips, Andrew N. ; Cambiano, Valentina ; Nakagawa, Fumiyo ; Bansi-Matharu, Loveleen ; Sow, Papa Salif ; Ehrenkranz, Peter ; Ford, Deborah ; Mugurungi, Owen ; Apollo, Tsitsi ; Murungu, Joseph ; Bangsberg, David R. ; Revill, Paul. / Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa. In: PLoS ONE. 2016 ; Vol. 11, No. 12. pp. 1-20.

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@article{ddbf6ae8bcdf43829718e0958197907d,
title = "Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa",
abstract = "Background Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. Methods An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. Findings In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6{\%} increase in the proportion of ART experienced people with viral load <1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement. Conclusion The cost thresholds identified suggest that there is clear scope for adherence monitoringbased interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit.",
author = "Phillips, {Andrew N.} and Valentina Cambiano and Fumiyo Nakagawa and Loveleen Bansi-Matharu and Sow, {Papa Salif} and Peter Ehrenkranz and Deborah Ford and Owen Mugurungi and Tsitsi Apollo and Joseph Murungu and Bangsberg, {David R.} and Paul Revill",
note = "{\circledC} 2016 Phillips et al.",
year = "2016",
month = "12",
day = "15",
doi = "10.1371/journal.pone.0167654",
language = "English",
volume = "11",
pages = "1--20",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "12",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa

AU - Phillips, Andrew N.

AU - Cambiano, Valentina

AU - Nakagawa, Fumiyo

AU - Bansi-Matharu, Loveleen

AU - Sow, Papa Salif

AU - Ehrenkranz, Peter

AU - Ford, Deborah

AU - Mugurungi, Owen

AU - Apollo, Tsitsi

AU - Murungu, Joseph

AU - Bangsberg, David R.

AU - Revill, Paul

N1 - © 2016 Phillips et al.

PY - 2016/12/15

Y1 - 2016/12/15

N2 - Background Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. Methods An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. Findings In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load <1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement. Conclusion The cost thresholds identified suggest that there is clear scope for adherence monitoringbased interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit.

AB - Background Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. Methods An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. Findings In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load <1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement. Conclusion The cost thresholds identified suggest that there is clear scope for adherence monitoringbased interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit.

UR - http://www.scopus.com/inward/record.url?scp=85006312856&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0167654

DO - 10.1371/journal.pone.0167654

M3 - Article

VL - 11

SP - 1

EP - 20

JO - PLoS ONE

T2 - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 12

M1 - e0167654

ER -