The Cost-Effectiveness of Counseling Strategies to Improve Adherence to Highly Active Antiretroviral Therapy among Men Who Have Sex with Men

Ivey School of Business, University of Western Ontario, London, Ontario, Canada.
Medical Decision Making (Impact Factor: 3.24). 02/2008; 28(3):359-76. DOI: 10.1177/0272989X07312714
Source: PubMed


Inadequate adherence to highly active antiretroviral therapy (HAART) may lead to poor health outcomes and the development of HIV strains that are resistant to HAART. The authors developed a model to evaluate the cost-effectiveness of counseling interventions to improve adherence to HAART among men who have sex with men (MSM).
The authors developed a dynamic compartmental model that incorporates HIV treatment, adherence to treatment, and infection transmission and progression. All data estimates were obtained from secondary sources. The authors evaluated a counseling intervention given prior to initiation of HAART and before all changes in drug regimens, combined with phone-in support while on HAART. They considered a moderate-prevalence and a high-prevalence population of MSM.
If the impact of HIV transmission is ignored, the counseling intervention has a cost-effectiveness ratio of $25,500 per quality-adjusted life year (QALY) gained. When HIV transmission is included, the cost-effectiveness ratio is much lower: $7400 and $8700 per QALY gained in the moderate- and high-prevalence populations, respectively. When the intervention is twice as costly per counseling session and half as effective as estimated in the base case (in terms of the number of individuals who become highly adherent, and who remain highly adherent), then the intervention costs $17,100 and $19,600 per QALY gained in the 2 populations, respectively.
Counseling to improve adherence to HAART increased length of life, modestly reduced HIV transmission, and cost substantially less than $50,000 per QALY gained over a wide range of assumptions but did not reduce the proportion of drug-resistant strains. Such counseling provides only modest benefit as a tool for HIV prevention but can provide significant benefit for individual patients at an affordable cost.

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    • "There have been several evaluations of interventions to improve compliance with ART in terms of their effectiveness [8–10], cost [11], and cost-effectiveness [12] but these are mostly focused on the patient interventions and mostly set in high-income countries. Of those examining provider or facility interventions [13], we found only one that evaluated an adherence improvement strategy in a low-income country setting [14]. "
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