Table 2.
Model-projected clinical outcomes, costs, and cost-effectiveness of different strategies for the prevention, diagnosis, and treatment of advanced HIV disease among people living with HIV in Malawi
|
1 year decrease in deaths*(%) |
1 year survival†(%) | Undiscounted QALYs | Discounted QALYs‡ | Discounted lifetime costs (US$)†‡ | ICER($/QALY)§¶ | ||||
|---|---|---|---|---|---|---|---|---|---|
| Tuberculosis (%) | Cryptococcal meningitis (%) | Serious bacterial infections (%) | |||||||
| All individuals presenting for outpatient ART initiation or reinitiation | |||||||||
| ART only | .. | .. | .. | 91·56% | 17·45 | 11·28 | 1450 | .. | |
| + Xpert | 25% | (2%) | (1%) | 92·74% | 18·48 | 11·81 | 1540 | Dominated | |
| + Xpert + CrAg | 25% | 28% | (1%) | 92·75% | 18·48 | 11·81 | 1540 | 170 | |
| + Xpert + LAM | 28% | (3%) | (2%) | 92·88% | 18·67 | 11·90 | 1580 | Dominated | |
| + Xpert + LAM + CrAg | 28% | 27% | (1%) | 92·89% | 18·67 | 11·90 | 1580 | Dominated | |
| + Xpert + LAM + TPT | 31% | (2%) | (1%) | 93·02% | 18·76 | 11·96 | 1590 | Dominated | |
| + Xpert + LAM + CrAg + TPT | 31% | 25% | (1%) | 93·05% | 18·76 | 11·96 | 1590 | 310 | |
| + Xpert + CTX | 24% | (3%) | 38% | 93·23% | 19·01 | 12·09 | 1700 | Dominated | |
| + Xpert + CTX + CrAg | 24% | 26% | 38% | 93·24% | 19·02 | 12·09 | 1700 | Dominated | |
| + Xpert + LAM + CTX | 27% | (4%) | 38% | 93·36% | 19·21 | 12·18 | 1740 | Dominated | |
| + Xpert + LAM + CTX + CrAg | 27% | 26% | 38% | 93·38% | 19·22 | 12·18 | 1740 | Dominated | |
| + Xpert + LAM + CTX + TPT | 30% | (4%) | 38% | 93·52% | 19·31 | 12·24 | 1750 | Dominated | |
| WHO-recommended advanced HIV disease package | 30% | 25% | 38% | 93·54% | 19·30 | 12·24 | 1750 | 580 | |
ART=antiretroviral therapy. CrAg=cryptococcal antigen. CTX=co-trimoxazole. ICER=incremental cost-effectiveness ratio. LAM=lateral flow lipoarabinomannan. QALY=quality-adjusted life year. TPT=tuberculosis preventive therapy.
Each strategy compared with ART only clinical outcomes. All values are a decrease in deaths at 1 year, unless in parentheses, which signifies an increase in deaths at 1 year; additional deaths can occur due to competing risks of mortality (eg, when fewer people die due to tuberculosis, there can be an increase in deaths due to serious bacterial infections). Bolded strategies offer the greatest value compared with the others.
The percentage of the cohort that survives 1 year in the model.
Discounted at 3% per year.
Reported total costs and ICERs are rounded to the nearest $10.
Strategies are dominated if an intervention has a higher ICER than that of another intervention that provides more QALYs. We report undiscounted health outcomes but use discounted clinical and cost outcomes to calculate ICERs, as recommended by the Second Panel on Cost-effectiveness in Health and Medicine.63