Cost-effectiveness and cost-utility of the adherence improving self-management strategy in human immunodeficiency virus care: A trial-based economic evaluation

Ben F. M. Wijnen, Edwin J. M. Oberjé, Silvia M. A. A. Evers, Jan M. Prins, Hans-Erik Nobel, Cees van Nieuwkoop, Jan Veenstra, Frank J. Pijnappel, Frank P. Kroon, Laura van Zonneveld, Astrid G. W. van Hulzen, Marjolein van Broekhuizen, Marijn de Bruin

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background. Several promising human immunodeficiency virus (HIV) treatment adherence interventions have been identified, but data about their cost-effectiveness are lacking. This study examines the trial-based cost-effectiveness and cost-utility of the proven- effective Adherence Improving Self-Management Strategy (AIMS), from a societal perspective, with a 15-month time horizon. Methods. Treatment-naive and treatment-experienced patients at risk for viral rebound were randomized to treatment as usual (TAU) or AIMS in a multicenter randomized controlled trial in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (2 consecutive detectable viral loads), and quality-adjusted life-years (QALYs). Results. Two hundred twenty-three patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an incremental cost-effectiveness ratio (ICER) of €549 per reduction in log10 viral load and €1659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of € 27 759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU. Conclusions. Base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a lifetime horizon showing that AIMS is cost-effective. Clinical Trials Registration. NCT01429142.
Original languageEnglish
Pages (from-to)658-667
JournalClinical Infectious Diseases
Volume68
Issue number4
DOIs
Publication statusPublished - 2019

Cite this

Wijnen, Ben F. M. ; Oberjé, Edwin J. M. ; Evers, Silvia M. A. A. ; Prins, Jan M. ; Nobel, Hans-Erik ; van Nieuwkoop, Cees ; Veenstra, Jan ; Pijnappel, Frank J. ; Kroon, Frank P. ; van Zonneveld, Laura ; van Hulzen, Astrid G. W. ; van Broekhuizen, Marjolein ; de Bruin, Marijn. / Cost-effectiveness and cost-utility of the adherence improving self-management strategy in human immunodeficiency virus care: A trial-based economic evaluation. In: Clinical Infectious Diseases. 2019 ; Vol. 68, No. 4. pp. 658-667.
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title = "Cost-effectiveness and cost-utility of the adherence improving self-management strategy in human immunodeficiency virus care: A trial-based economic evaluation",
abstract = "Background. Several promising human immunodeficiency virus (HIV) treatment adherence interventions have been identified, but data about their cost-effectiveness are lacking. This study examines the trial-based cost-effectiveness and cost-utility of the proven- effective Adherence Improving Self-Management Strategy (AIMS), from a societal perspective, with a 15-month time horizon. Methods. Treatment-naive and treatment-experienced patients at risk for viral rebound were randomized to treatment as usual (TAU) or AIMS in a multicenter randomized controlled trial in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (2 consecutive detectable viral loads), and quality-adjusted life-years (QALYs). Results. Two hundred twenty-three patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an incremental cost-effectiveness ratio (ICER) of €549 per reduction in log10 viral load and €1659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of € 27 759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU. Conclusions. Base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a lifetime horizon showing that AIMS is cost-effective. Clinical Trials Registration. NCT01429142.",
author = "Wijnen, {Ben F. M.} and Oberj{\'e}, {Edwin J. M.} and Evers, {Silvia M. A. A.} and Prins, {Jan M.} and Hans-Erik Nobel and {van Nieuwkoop}, Cees and Jan Veenstra and Pijnappel, {Frank J.} and Kroon, {Frank P.} and {van Zonneveld}, Laura and {van Hulzen}, {Astrid G. W.} and {van Broekhuizen}, Marjolein and {de Bruin}, Marijn",
year = "2019",
doi = "10.1093/cid/ciy553",
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Wijnen, BFM, Oberjé, EJM, Evers, SMAA, Prins, JM, Nobel, H-E, van Nieuwkoop, C, Veenstra, J, Pijnappel, FJ, Kroon, FP, van Zonneveld, L, van Hulzen, AGW, van Broekhuizen, M & de Bruin, M 2019, 'Cost-effectiveness and cost-utility of the adherence improving self-management strategy in human immunodeficiency virus care: A trial-based economic evaluation' Clinical Infectious Diseases, vol. 68, no. 4, pp. 658-667. https://doi.org/10.1093/cid/ciy553

Cost-effectiveness and cost-utility of the adherence improving self-management strategy in human immunodeficiency virus care: A trial-based economic evaluation. / Wijnen, Ben F. M.; Oberjé, Edwin J. M.; Evers, Silvia M. A. A.; Prins, Jan M.; Nobel, Hans-Erik; van Nieuwkoop, Cees; Veenstra, Jan; Pijnappel, Frank J.; Kroon, Frank P.; van Zonneveld, Laura; van Hulzen, Astrid G. W.; van Broekhuizen, Marjolein; de Bruin, Marijn.

In: Clinical Infectious Diseases, Vol. 68, No. 4, 2019, p. 658-667.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Cost-effectiveness and cost-utility of the adherence improving self-management strategy in human immunodeficiency virus care: A trial-based economic evaluation

AU - Wijnen, Ben F. M.

AU - Oberjé, Edwin J. M.

AU - Evers, Silvia M. A. A.

AU - Prins, Jan M.

AU - Nobel, Hans-Erik

AU - van Nieuwkoop, Cees

AU - Veenstra, Jan

AU - Pijnappel, Frank J.

AU - Kroon, Frank P.

AU - van Zonneveld, Laura

AU - van Hulzen, Astrid G. W.

AU - van Broekhuizen, Marjolein

AU - de Bruin, Marijn

PY - 2019

Y1 - 2019

N2 - Background. Several promising human immunodeficiency virus (HIV) treatment adherence interventions have been identified, but data about their cost-effectiveness are lacking. This study examines the trial-based cost-effectiveness and cost-utility of the proven- effective Adherence Improving Self-Management Strategy (AIMS), from a societal perspective, with a 15-month time horizon. Methods. Treatment-naive and treatment-experienced patients at risk for viral rebound were randomized to treatment as usual (TAU) or AIMS in a multicenter randomized controlled trial in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (2 consecutive detectable viral loads), and quality-adjusted life-years (QALYs). Results. Two hundred twenty-three patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an incremental cost-effectiveness ratio (ICER) of €549 per reduction in log10 viral load and €1659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of € 27 759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU. Conclusions. Base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a lifetime horizon showing that AIMS is cost-effective. Clinical Trials Registration. NCT01429142.

AB - Background. Several promising human immunodeficiency virus (HIV) treatment adherence interventions have been identified, but data about their cost-effectiveness are lacking. This study examines the trial-based cost-effectiveness and cost-utility of the proven- effective Adherence Improving Self-Management Strategy (AIMS), from a societal perspective, with a 15-month time horizon. Methods. Treatment-naive and treatment-experienced patients at risk for viral rebound were randomized to treatment as usual (TAU) or AIMS in a multicenter randomized controlled trial in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (2 consecutive detectable viral loads), and quality-adjusted life-years (QALYs). Results. Two hundred twenty-three patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an incremental cost-effectiveness ratio (ICER) of €549 per reduction in log10 viral load and €1659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of € 27 759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU. Conclusions. Base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a lifetime horizon showing that AIMS is cost-effective. Clinical Trials Registration. NCT01429142.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30239629

U2 - 10.1093/cid/ciy553

DO - 10.1093/cid/ciy553

M3 - Article

VL - 68

SP - 658

EP - 667

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 4

ER -