PMID: 9440663Jan 24, 1998Paper

The cost-effectiveness of preventing AIDS-related opportunistic infections

JAMA : the Journal of the American Medical Association
Kenneth A FreedbergA D Paltiel

Abstract

Multiple options are now available for prophylaxis of opportunistic infections related to the acquired immunodeficiency syndrome (AIDS). However, because of differences in incidence rates as well as drug efficacy, toxicity, and costs, the role of different types of prophylaxis remains uncertain. To determine the clinical impact, cost, and cost-effectiveness of strategies for preventing opportunistic infections in patients with advanced human immunodeficiency virus (HIV) disease. We developed a Markov simulation model to compare different strategies for prophylaxis of Pneumocystis carinii pneumonia (PCP), toxoplasmosis, Mycobacterium avium complex (MAC) infection, fungal infections, and cytomegalovirus (CMV) disease in HIV-infected patients. Data for the model were derived from the Multicenter AIDS Cohort Study, randomized controlled trials, and the national AIDS Cost and Services Utilization Survey. Projected life expectancy, quality-adjusted life expectancy, total lifetime direct medical costs, and cost-effectiveness in dollars per quality-adjusted life-year (QALY) saved. For patients with CD4 cell counts of 0.200 to 0.300 x 10(9)/L (200-300/microL) who receive no prophylaxis, we projected a quality-adjusted life expectancy of...Continue Reading

Citations

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