Table 3.
Cost-effectiveness of strategies to reduce transmitted drug resistance by treatment initiation threshold
| Intervention | Total cost (millions USD) | QALYs gained | Infections averted | Average cost-effectiveness ratio | Incremental cost- effectiveness ratio | Conclusions |
|---|---|---|---|---|---|---|
| Treatment at CD4 <350 | 33.8 (31.6–36.0) | |||||
| Increase second-line | 34.0 (31.7–36.2) | 81 (−199–351) | 104 (83–130) | $1925 ($450-dominated) | $1925 ($450-dominated) | Cost-effective |
| Viral load every 6 months, for first 2 years on treatment | 34.1 (31.8–36.4) | 3 (−250–280) | 9 (6–12) | $95,417 ($1077-dominated) | Dominated ($725-dominated) | Dominated |
| Viral load every 6 months, for first 2 years on treatment and increased second-line | 34.2 (31.9–36.4) | 29 (−234–287) | 31 (23–40) | $11,602 ($1216-dominated) | Dominated ($908-dominated) | Dominated |
| Pre-therapy genotyping | 34.6 (32.3–37.0) | 3 (−285–273) | 7 (5–10) | $329,018 ($3014-dominated) | Dominated ($3387-dominated) | Dominated |
| Continual viral load every 6 months | 38.4 (35.9–41.0) | 16 (−258–297) | 25 (18–34) | $283,020 ($15,844-dominated) | Dominated ($24,765-dominated) | Dominated |
| Continual viral load every 6 months and increased second-line | 38.5 (35.9–41.1) | 75 (−170–329) | 98 (75–126) | $64,539 ($13,884-dominated) | Dominated ($18,177-dominated) | Dominated |
| Treatment at CD4 <500 | 38.5 (36.0–41.3) | |||||
| Increase second-line | 38.7 (36.2–41.5) | 87 (−190–375) | 132 (105–165) | $2234 ($505-dominated) | $2234 ($505-dominated) | Cost-effective |
| Viral load every 6 months, for first 2 years on treatment | 38.9 (36.4–41.7) | −12 (−302–288) | 12 (8–18) | Dominated ($1431-dominated) | Dominated | Dominated |
| Viral load every 6 months, for first 2 years on treatment and increased second-line | 39.0 (36.5–41.8) | 26 (−277–318) | 43 (33–56) | $18,337 ($1473-dominated) | Dominated ($1290-dominated) | Dominated |
| Pre-therapy genotyping | 39.6 (37.1–42.5) | −18 (−298–309) | 13 (9–17) | Dominated ($3734-dominated) | Dominated | Dominated |
| Continual viral load every 6 months | 44.0 (41.1–47.1) | 2 (−290–310) | 33 (24–43) | Dominated ($28,250-dominated) | Dominated | Dominated |
| Continual viral load every 6 months and increased second-line | 44.0 (41.2–47.2) | 70 (−208–366) | 122 (95–157) | $72,975 ($15,593-dominated) | Dominated ($21,720-dominated) | Dominated |
| Treat immediately | 39.9 (37.4–42.9) | |||||
| Increase second-line | 40.1 (37.5–43.0) | 121 (−165–406) | 137 (109–169) | $1612 ($463-dominated) | $1612 ($463-dominated) | Cost-effective |
| Viral load every 6 months, for first 2 years on treatment | 40.4 (37.7–43.4) | 17 (−292–331) | 13 (9–19) | $25,767 ($1276-dominated) | Dominated ($1315-dominated) | Dominated |
| Viral load every 6 months, for first 2 years on treatment and increased second-line | 40.4 (37.8–43.4) | 33 (−276–344) | 46 (34–58) | $15,100 ($1517-dominated) | Dominated ($1544-dominated) | Dominated |
| Pre-therapy genotyping | 41.2 (38.5–44.2) | 18 (−329–341) | 14 (10–19) | $69,252 ($3620-dominated) | Dominated ($4541-dominated) | Dominated |
| Continual viral load every 6 months | 45.6 (42.7–49.0) | 19 (−276–320) | 34 (25–45) | $292,107 ($17,550-dominated) | Dominated ($27,785-dominated) | Dominated |
| Continual viral load every 6 months and increased second-line | 45.8 (42.8–49.1) | 81 (−212–355) | 127 (97–160) | $69,140 ($16,409-dominated) | Dominated ($20,685-dominated) | Dominated |
Within each treatment initiation stratum, average and incremental cost-effectiveness ratios are calculated based on the total additional cost and QALYs gained.