COST-EFFECTIVENESS OF PREVENTING AIDS COMPLICATIONS

预防艾滋病并发症的成本效益

• 批准号: 2236016
• 负责人: Kenneth Alan Freedberg
• 金额: $ 18.91万
• 依托单位: BOSTON HEALTH AND HOSPITALS DEPARTMENT
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-08-01 至 1997-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2236016
• 关键词: AIDS therapy; HIV infections; Herpesviridae disease; Mycobacterium avium; Pneumocystis pneumonia; antiAIDS agent; candidiasis; chemoprevention; computer assisted medical decision making; cytomegalovirus; dapsone; fluconazole; health care cost /financing; health care model; helper T lymphocyte; human subject; model design /development; opportunistic infections; pentamidine; statistics /biometry; sulfamethoxazole; trimethoprim

Prevention of AIDS-related opportunistic infections (OI's) offers a major opportunity to improve both the quality and length of life of patients suffering from this devastating disease. Clinical studies have demonstrated the efficacy of prophylaxis in preventing the major 01's associated with AIDS. The Cost of prevention is high, however, and may add substantially to the estimated $5 billion per year currently spent on AIDS care in the United States. Previous research on cost-effective approaches to HIV care has focused on specific strategies for prophylaxis against individual 01's. It may be more appropriate, however, for physicians and policy makers to treat the epidemic as a family of interdependent diseases, assessing the costs and effects of integrated prophylactic strategies, in order to determine the impact of prevention regimens on HIV-related expenditures. Pneumocystis carinii pneumonia (PCP), Mycobacterium avium Complex (MAC), cytomegalovirus (CMV) and fungal infections are the most common OI's in AIDS patients. Large randomized trials of prophylaxis, under the auspices of the national AIDS Clinical Trials Group (ACTG), are in the process of assessing the efficacy of preventive therapies. These include: aerosolized pentamidine, trimethoprim-sulfamethoxazole, and dapsone for PCP prophylaxis; rifabutin and/or clarithromycin for MAC prophylaxis; valaciclovir to prevent CMV; and clotrimazole troches and oral fluconazole for the prevention of fungal infections. Little research has been conducted, however, to evaluate the downstream economic consequences of widespread implementation of these interventions. In order to evaluate the alternative strategies for the prevention of OI's in people with AIDS, we propose to embed new clinical and cost data from recent randomized trials and observational cohorts into the structure of a comprehensive, decision-analytic, cost-effectiveness model. We will employ a state-transition (or Markov) framework to simulate the natural history of HIV and its major associated OI's and to assess the costs, benefits, and cost-effectiveness of prophylaxis. To capture both the complexity and the rapid rate of technological change that characterize the clinical management of patients with HIV infection, the model we propose is dynamic in its nature and flexible in its structure: it can be expanded to incorporate data on other covariates, such as the effects of a future vaccine or prophylaxis against other OI's. Such timely and essential information will be vital to clinicians and policy makers for the development of rational approaches to the management of the HlV epidemic.

预防与艾滋病相关的机会性感染（OI）提供了主要 改善患者寿命的机会 患有这种毁灭性疾病。临床研究已有 证明了预防在防止主要01的功效 与艾滋病相关。但是，预防成本很高，可能会增加 目前，目前每年估计每年花费50亿美元 在美国的护理。先前关于具有成本效益的方法的研究 艾滋病毒护理专注于预防的特定策略 个人01。但是，对于医生和 政策制定者将流行病视为一个相互依存的家族 疾病，评估综合预防性的成本和影响 策略，以确定预防方案对 与HIV相关的支出。 肺炎史蒂斯·卡里尼肺炎（PCP），分枝杆菌鸟体综合体（MAC）， 巨细胞病毒（CMV）和真菌感染是最常见的OI 艾滋病患者。主持人下的大型预防随机试验 国家艾滋病临床试验小组（ACTG）的 评估预防疗法的功效。 其中包括： 气溶解戊二胺，甲氧苄啶 - 磺胺甲氧唑和Dapsone用于 PCP预防；利法布丁和/或克拉霉素用于MAC预防； valaciclovir以防止CMV；以及克替三唑托克斯和口服氟康唑 用于预防真菌感染。 研究很少 但是，进行了评估 这些干预措施的广泛实施。 为了评估预防OI的替代策略 在有艾滋病的人中，我们建议从 最近的随机试验和观察人群 一个全面的，决策分析，成本效益模型。我们将 采用国家转变（或马尔可夫）框架来模拟自然 艾滋病毒的历史及其主要相关的OI并评估成本， 预防的好处和成本效益。捕获两个 复杂性和技术变化的快速率 艾滋病毒感染患者的临床管理，模型我们 提议的本质是动态的，并且在其结构上是灵活的：它可以是 扩展以合并其他协变量的数据，例如 针对其他OI的未来疫苗或预防。这样的及时 基本信息对临床医生和政策制定者至关重要 发展HLV管理的理性方法的发展 流行性。