Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine: Balancing efficacy and cost

Charles Holmes, Hui Zheng, Neil A. Martinson, Kenneth A. Freedberg, Rochelle P. Walensky

Research output: Contribution to journalArticle

Abstract

Introduction. Nevirapine (NVP) resistance may decrease the effectiveness of viral suppression with NVP-based antiretroviral therapy (ART) in women infected with human immunodeficiency virus (HIV) with previous exposure to single-dose NVP. However, the alternative lopinavir-ritonavir-based ART regimen is more expensive. Our objectives were to project the tradeoffs regarding life expectancy, cost, and cost-effectiveness of these ART regimens for NVP-exposed, HIV-infected women in South Africa. Methods. We developed a simulation model in which NVP-exposed, HIV-infected South African women received 1 of 5 treatment strategies: HIV care without ART, NVP-based ART, lopinavir-ritonavir-based ART, NVP-based ART followed by lopinavir-ritonavir-based ART, or lopinavir-ritonavir- based ART followed by NVP-based ART. The prevalence of NVP resistance was 39%; other data were obtained from the published literature. Results. Projected life expectancy was 43.7 months for women who did not receive ART, 77.4 months for women who received a single NVP-based regimen, and 84.5 months for women who received a single lopinavir-ritonavir-based regimen. NVP resistance reduced survival time by up to 11.6 months among women who received NVP-based ART. The cost-effectiveness of NVP-based ART was $800 (US dollars) per year of life saved, compared with no ART, and the cost-effectiveness of lopinavir-ritonavir-based therapy was $4400 per year of life saved, compared with NVP-based ART. Lopinavir-ritonavir followed by NVP-based ART yielded the greatest life expectancy (105.4 months), had a cost-effectiveness of $2300 per year of life saved, and, if the efficacy of NVP-based regimens improved >6 months postpartum, further increased survival. Conclusions. NVP resistance substantially decreased the projected survival time associated with NVP-based ART, and lopinavir-ritonavir-based ART resulted in a superior survival time but at higher cost. A sequential regimen starting with lopinavir-ritonavir-based ART followed by NVP-based ART maximized projected survival and was cost effective in South Africa.

Original languageEnglish (US)
Pages (from-to)1772-1780
Number of pages9
JournalClinical Infectious Diseases
Volume42
Issue number12
DOIs
StatePublished - Jun 15 2006
Externally publishedYes

Fingerprint

Nevirapine
HIV
Costs and Cost Analysis
Lopinavir
Ritonavir
Therapeutics
Cost-Benefit Analysis
Life Expectancy
Survival
South Africa

ASJC Scopus subject areas

  • Immunology

Cite this

Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine : Balancing efficacy and cost. / Holmes, Charles; Zheng, Hui; Martinson, Neil A.; Freedberg, Kenneth A.; Walensky, Rochelle P.

In: Clinical Infectious Diseases, Vol. 42, No. 12, 15.06.2006, p. 1772-1780.

Research output: Contribution to journalArticle

Holmes, Charles ; Zheng, Hui ; Martinson, Neil A. ; Freedberg, Kenneth A. ; Walensky, Rochelle P. / Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine : Balancing efficacy and cost. In: Clinical Infectious Diseases. 2006 ; Vol. 42, No. 12. pp. 1772-1780.
@article{17d9d151a6044e6f85c05e6d507f51db,
title = "Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine: Balancing efficacy and cost",
abstract = "Introduction. Nevirapine (NVP) resistance may decrease the effectiveness of viral suppression with NVP-based antiretroviral therapy (ART) in women infected with human immunodeficiency virus (HIV) with previous exposure to single-dose NVP. However, the alternative lopinavir-ritonavir-based ART regimen is more expensive. Our objectives were to project the tradeoffs regarding life expectancy, cost, and cost-effectiveness of these ART regimens for NVP-exposed, HIV-infected women in South Africa. Methods. We developed a simulation model in which NVP-exposed, HIV-infected South African women received 1 of 5 treatment strategies: HIV care without ART, NVP-based ART, lopinavir-ritonavir-based ART, NVP-based ART followed by lopinavir-ritonavir-based ART, or lopinavir-ritonavir- based ART followed by NVP-based ART. The prevalence of NVP resistance was 39{\%}; other data were obtained from the published literature. Results. Projected life expectancy was 43.7 months for women who did not receive ART, 77.4 months for women who received a single NVP-based regimen, and 84.5 months for women who received a single lopinavir-ritonavir-based regimen. NVP resistance reduced survival time by up to 11.6 months among women who received NVP-based ART. The cost-effectiveness of NVP-based ART was $800 (US dollars) per year of life saved, compared with no ART, and the cost-effectiveness of lopinavir-ritonavir-based therapy was $4400 per year of life saved, compared with NVP-based ART. Lopinavir-ritonavir followed by NVP-based ART yielded the greatest life expectancy (105.4 months), had a cost-effectiveness of $2300 per year of life saved, and, if the efficacy of NVP-based regimens improved >6 months postpartum, further increased survival. Conclusions. NVP resistance substantially decreased the projected survival time associated with NVP-based ART, and lopinavir-ritonavir-based ART resulted in a superior survival time but at higher cost. A sequential regimen starting with lopinavir-ritonavir-based ART followed by NVP-based ART maximized projected survival and was cost effective in South Africa.",
author = "Charles Holmes and Hui Zheng and Martinson, {Neil A.} and Freedberg, {Kenneth A.} and Walensky, {Rochelle P.}",
year = "2006",
month = "6",
day = "15",
doi = "10.1086/504382",
language = "English (US)",
volume = "42",
pages = "1772--1780",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "12",

}

TY - JOUR

T1 - Optimizing treatment for HIV-infected South African women exposed to single-dose nevirapine

T2 - Balancing efficacy and cost

AU - Holmes, Charles

AU - Zheng, Hui

AU - Martinson, Neil A.

AU - Freedberg, Kenneth A.

AU - Walensky, Rochelle P.

PY - 2006/6/15

Y1 - 2006/6/15

N2 - Introduction. Nevirapine (NVP) resistance may decrease the effectiveness of viral suppression with NVP-based antiretroviral therapy (ART) in women infected with human immunodeficiency virus (HIV) with previous exposure to single-dose NVP. However, the alternative lopinavir-ritonavir-based ART regimen is more expensive. Our objectives were to project the tradeoffs regarding life expectancy, cost, and cost-effectiveness of these ART regimens for NVP-exposed, HIV-infected women in South Africa. Methods. We developed a simulation model in which NVP-exposed, HIV-infected South African women received 1 of 5 treatment strategies: HIV care without ART, NVP-based ART, lopinavir-ritonavir-based ART, NVP-based ART followed by lopinavir-ritonavir-based ART, or lopinavir-ritonavir- based ART followed by NVP-based ART. The prevalence of NVP resistance was 39%; other data were obtained from the published literature. Results. Projected life expectancy was 43.7 months for women who did not receive ART, 77.4 months for women who received a single NVP-based regimen, and 84.5 months for women who received a single lopinavir-ritonavir-based regimen. NVP resistance reduced survival time by up to 11.6 months among women who received NVP-based ART. The cost-effectiveness of NVP-based ART was $800 (US dollars) per year of life saved, compared with no ART, and the cost-effectiveness of lopinavir-ritonavir-based therapy was $4400 per year of life saved, compared with NVP-based ART. Lopinavir-ritonavir followed by NVP-based ART yielded the greatest life expectancy (105.4 months), had a cost-effectiveness of $2300 per year of life saved, and, if the efficacy of NVP-based regimens improved >6 months postpartum, further increased survival. Conclusions. NVP resistance substantially decreased the projected survival time associated with NVP-based ART, and lopinavir-ritonavir-based ART resulted in a superior survival time but at higher cost. A sequential regimen starting with lopinavir-ritonavir-based ART followed by NVP-based ART maximized projected survival and was cost effective in South Africa.

AB - Introduction. Nevirapine (NVP) resistance may decrease the effectiveness of viral suppression with NVP-based antiretroviral therapy (ART) in women infected with human immunodeficiency virus (HIV) with previous exposure to single-dose NVP. However, the alternative lopinavir-ritonavir-based ART regimen is more expensive. Our objectives were to project the tradeoffs regarding life expectancy, cost, and cost-effectiveness of these ART regimens for NVP-exposed, HIV-infected women in South Africa. Methods. We developed a simulation model in which NVP-exposed, HIV-infected South African women received 1 of 5 treatment strategies: HIV care without ART, NVP-based ART, lopinavir-ritonavir-based ART, NVP-based ART followed by lopinavir-ritonavir-based ART, or lopinavir-ritonavir- based ART followed by NVP-based ART. The prevalence of NVP resistance was 39%; other data were obtained from the published literature. Results. Projected life expectancy was 43.7 months for women who did not receive ART, 77.4 months for women who received a single NVP-based regimen, and 84.5 months for women who received a single lopinavir-ritonavir-based regimen. NVP resistance reduced survival time by up to 11.6 months among women who received NVP-based ART. The cost-effectiveness of NVP-based ART was $800 (US dollars) per year of life saved, compared with no ART, and the cost-effectiveness of lopinavir-ritonavir-based therapy was $4400 per year of life saved, compared with NVP-based ART. Lopinavir-ritonavir followed by NVP-based ART yielded the greatest life expectancy (105.4 months), had a cost-effectiveness of $2300 per year of life saved, and, if the efficacy of NVP-based regimens improved >6 months postpartum, further increased survival. Conclusions. NVP resistance substantially decreased the projected survival time associated with NVP-based ART, and lopinavir-ritonavir-based ART resulted in a superior survival time but at higher cost. A sequential regimen starting with lopinavir-ritonavir-based ART followed by NVP-based ART maximized projected survival and was cost effective in South Africa.

UR - http://www.scopus.com/inward/record.url?scp=33744791736&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744791736&partnerID=8YFLogxK

U2 - 10.1086/504382

DO - 10.1086/504382

M3 - Article

C2 - 16705586

AN - SCOPUS:33744791736

VL - 42

SP - 1772

EP - 1780

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 12

ER -