HIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?
Berkowitz, Bethany K.
Morris, Bethany L.
Paltiel, A. David
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CitationSax, 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.
AbstractBackground: 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.
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