Luz, Paula M.Morris, Bethany L.Grinsztejn, BeatrizFreedberg, KennethVeloso, Valdilea G.Walensky, RochelleLosina, ElenaNakamura, Yoriko M.Girouard, Michael P.Sax, PaulStruchiner, Claudio J.Paltiel, A. David2015-02-022014Luz, P. M., B. L. Morris, B. Grinsztejn, K. A. Freedberg, V. G. Veloso, R. P. Walensky, E. Losina, et al. 2014. “Cost-Effectiveness of Genotype Testing for Primary Resistance in Brazil.” Journal of Acquired Immune Deficiency Syndromes (1999) 68 (2): 152-161. doi:10.1097/QAI.0000000000000426. http://dx.doi.org/10.1097/QAI.0000000000000426.1525-4135http://nrs.harvard.edu/urn-3:HUL.InstRepos:13890599Objective: HIV genotype-resistance testing can help identify more effective antiretroviral treatment (ART) regimens for patients, substantially increasing the likelihood of viral suppression and immune recovery. We sought to evaluate the cost-effectiveness of genotype-resistance testing before first-line ART initiation in Brazil. Design: We used a previously published microsimulation model of HIV disease (CEPAC-International) and data from Brazil to compare the clinical impact, costs, and cost-effectiveness of initial genotype testing (Genotype) with no initial genotype testing (No genotype). Methods: Model parameters were derived from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute and from published data, using Brazilian sources whenever possible. Baseline patient characteristics included 69% male, mean age of 36 years (SD, 10 years), mean CD4 count of 347 per microliter (SD, 300/µL) at ART initiation, annual ART costs from 2012 US $1400 to US $13,400, genotype test cost of US $230, and primary resistance prevalence of 4.4%. Life expectancy and costs were discounted 3% per year. Genotype was defined as “cost-effective” compared with No Genotype if its incremental cost-effectiveness ratio was less than 3 times the 2012 Brazilian per capita GDP of US $12,300. Results: Compared with No genotype, Genotype increased life expectancy from 18.45 to 18.47 years and reduced lifetime cost from US $45,000 to $44,770; thus, in the base case, Genotype was cost saving. Genotype was cost-effective at primary resistance prevalence as low as 1.4% and remained cost-effective when subsequent-line ART costs decreased to 30% of baseline value. Cost-inefficient results were observed only when simultaneously holding multiple parameters to extremes of their plausible ranges. Conclusions: Genotype-resistance testing in ART-naive individuals in Brazil will improve survival and decrease costs and should be incorporated into HIV treatment guidelines in Brazil.en-USgenotypecost-effectivenessBrazilHIVdrug resistanceJournal Article2015-02-0210.1097/QAI.0000000000000426