HIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?
Open/View files
Date
2014
Author(s)
Sypek, Alexis
Berkowitz, Bethany K.
Morris, Bethany L.
Paltiel, A. David
Eron, Joseph
Publisher
Public Library of Science
The Harvard community has made this article openly available. Please share how this access benefits you.
Citation
Sax, P. E., A. Sypek, B. K. Berkowitz, B. L. Morris, E. Losina, A. D. Paltiel, K. A. Kelly, et al. 2014. “HIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?” PLoS ONE 9 (11): e113031. doi:10.1371/journal.pone.0113031. http://dx.doi.org/10.1371/journal.pone.0113031.
Abstract
Background: We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART). Methods: We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY. Results: For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving. Conclusions: Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.
Other Available Sources
Terms of Use
This article is made available under the terms and conditions applicable to Other Posted Material (LAA), as set forth at Terms of Service
Subjects
Collection
Mapped collections