Table 4.
Input or assumption | Values/methods used | Most/least favourable ICER ($/DALY averted) | |||
---|---|---|---|---|---|
Base case | Most/least favourable* | Clinical/CD4 (v clinical) | Clinical/CD4/viral load (v clinical/CD4) | ||
Deaths per 100 person years (intention to treat): | |||||
Clinical/CD4/viral load, 95% CI†, other arms kept at base case | 3.7 | 2.22/6.11 | 174/174 | 1550/dominated‡ | |
Clinical/CD4, 95% CI†, other arms kept at base case | 4.1 | 2.55/6.48 | 368/1792§ | Dominated‡/1263 | |
Clinical, 95% CI†, other arms kept at base case | 5.8 | 9.10/3.70 | 454/2832§ | 5181/5181 | |
Deaths per 100 person years (per protocol): | |||||
Viral load arm, CD4 arm, clinical arm | Intention to treat (above) | NA/2.2, 2.0, 3.5 | NA/88 | NA/dominated‡ | |
Annual rate of regimen change: | |||||
Viral load arm, CD4 arm, clinical arm | 0.7%, 0.4%, 1.8% | 50-150% of base case values | 401/dominant‡ | 4882/5466 | |
Future DALYs averted and costs added per death: | |||||
Inclusion or exclusion of projections beyond trial | Included | NA/excluded | NA/307 | NA/10 257 | |
Unit costs of monitoring test kits: | |||||
CD4 | 3.80 | 1.90/5.70 | 233/115 | 5187/5175 | |
Viral load | 27.20 | 13.60/54.40 | 176/173 | 3322/7040 | |
Costs of antiretroviral drugs (annual; per person): | |||||
First line regimen | 125 | 63/188 | 73/275 | 5169/5193 | |
Second line regimen | 1119 | 557/1679 | 451/dominant‡ | 4825/5538 | |
Costs of opportunistic infection treatment: | |||||
Observed (base case) v imputed from rates of opportunistic infection | 122, 123, 127 | 97, 123, 194/NA | 1.06/NA | 4906/NA |
NA=not applicable.
*For cost effectiveness of laboratory testing.
†95% CI from clinical trial.11
‡Dominated=higher cost and fewer DALYs than comparator; dominant=cheaper and better.
§ICER for high end of mortality range represents reverse comparison among arms.