Clinical impact and cost of monitoring for asymptomatic laboratory abnormalities among patients receiving antiretroviral therapy in a resource-poor setting.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
Serena P KoenigDaniel W Fitzgerald

Abstract

Laboratory monitoring for toxicity among patients receiving antiretroviral therapy (ART) in less-developed settings is technically challenging and consumes significant resources. We conducted a cohort study of the 1800 adult patients who initiated ART at the Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) in Haiti from 2003 to 2006, using baseline data to establish the prevalence and using follow-up data to establish the incidence of hepatitis, renal insufficiency, hyperglycemia, anemia, neutropenia, and thrombocytopenia. We determined how frequently routine (not symptom-driven) testing detected significant laboratory abnormalities and calculated the cost per disability-adjusted life year (DALY) averted by detection of these events in the asymptomatic stage, compared with a strategy of symptom-prompted testing only. Forty-eight patients (3.5%) had severe anemia at baseline testing and consequently did not receive zidovudine. Fifty-three patients receiving zidovudine therapy developed severe anemia during follow-up (incidence, 2.5 cases/100 person-years). Monitoring for asymptomatic anemia with hematocrit testing was cost-saving at baseline and had a cost-effectiveness ratio of US$317/DALY averted...Continue Reading

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Citations

Feb 26, 2013·AIDS·Babafemi TaiwoUNKNOWN CFAR Network of Integrated Clinical Systems (CNICS) Cohort Study
Mar 1, 2013·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Elizabeth L YanikUNKNOWN Center for Aids Research Network of Integrated Clinical Systems (CNICS) Cohort Study
Jan 1, 2014·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Jean W PapeWarren D Johnson
Jun 12, 2013·Journal of Pharmaceutical Sciences·Kelen C C SoaresJennifer Dressman
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Feb 15, 2011·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Shilpa SayanaHomayoon Khanlou
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Dec 15, 2010·Current Opinion in Infectious Diseases·A Sarah Walker, Diana M Gibb
Jul 2, 2014·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Cynthia RiviereSerena P Koenig

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