Pharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with AIDS.
A decision-analytical simulation model was constructed to perform a pharmacoeconomic analysis of the following 3 treatment strategies for previously untreated cytomegalovirus (CMV) retinitis in patients with AIDS: (i) intravenous foscarnet (IVF) for induction and maintenance therapy; (ii) intravenou...
| Main Authors: | , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
1998
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| _version_ | 1797070496223723520 |
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| author | Griffiths, R Bleecker, G Jabs, D Dieterich, D Coleson, L Winters, D Wolitz, R Steinberg, E |
| author_facet | Griffiths, R Bleecker, G Jabs, D Dieterich, D Coleson, L Winters, D Wolitz, R Steinberg, E |
| author_sort | Griffiths, R |
| collection | OXFORD |
| description | A decision-analytical simulation model was constructed to perform a pharmacoeconomic analysis of the following 3 treatment strategies for previously untreated cytomegalovirus (CMV) retinitis in patients with AIDS: (i) intravenous foscarnet (IVF) for induction and maintenance therapy; (ii) intravenous ganciclovir (IVG) for induction and maintenance therapy; and (iii) intravenous ganciclovir for induction therapy, followed by oral ganciclovir for maintenance therapy (IVG-ORG). Patients who experienced significant adverse effects during, or who failed, initial therapy were switched once to one of the other 2 treatments. The model was used to estimate the direct medical cost (from the perspective of a public payer), survival, and survival adjusted for disutility because of lost vision, for each strategy in the first year following treatment initiation. The expected first-year costs of treatment initiated with IVF, IVG and IVG-ORG were $US47,918, $US38,817 and $US32,036 (1994 values), respectively, while expected first-year survival was 41 weeks, 35 weeks and 35 weeks, respectively. The incremental cost per incremental year of survival using IVF was $US78,000 versus IVG and $US138,000 versus IVG-ORG before adjustment for lost vision, and $US93,000 versus IVG and $US166,000 versus IVG-ORG after adjustment for lost vision. About 23% of the cost of the IVG treatment strategy was attributable to treatment-related adverse events, compared with 14% of the cost of IVF and 16% of the cost of IVG-ORG. Because of the high failure rate with IVG-ORG, initial treatment with IVG-ORG frequently led to switching to another treatment. Only 27% of the costs associated with the IVG-ORG treatment strategy were in fact attributable to the cost of induction and maintenance therapy prior to a switch to alternative treatment. In this analysis, initial treatment with IVG-ORG was the least costly approach for treating CMV retinitis in patients with AIDS. Initial treatment with IVF resulted in slightly longer survival adjusted for vision-related quality of life. New treatments for AIDS may reduce the survival benefit of initial treatment with IVF. |
| first_indexed | 2024-03-06T22:39:41Z |
| format | Journal article |
| id | oxford-uuid:5b1ea4b2-2d60-452f-b416-5435a0274b8a |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:39:41Z |
| publishDate | 1998 |
| record_format | dspace |
| spelling | oxford-uuid:5b1ea4b2-2d60-452f-b416-5435a0274b8a2022-03-26T17:20:07ZPharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with AIDS.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:5b1ea4b2-2d60-452f-b416-5435a0274b8aEnglishSymplectic Elements at Oxford1998Griffiths, RBleecker, GJabs, DDieterich, DColeson, LWinters, DWolitz, RSteinberg, EA decision-analytical simulation model was constructed to perform a pharmacoeconomic analysis of the following 3 treatment strategies for previously untreated cytomegalovirus (CMV) retinitis in patients with AIDS: (i) intravenous foscarnet (IVF) for induction and maintenance therapy; (ii) intravenous ganciclovir (IVG) for induction and maintenance therapy; and (iii) intravenous ganciclovir for induction therapy, followed by oral ganciclovir for maintenance therapy (IVG-ORG). Patients who experienced significant adverse effects during, or who failed, initial therapy were switched once to one of the other 2 treatments. The model was used to estimate the direct medical cost (from the perspective of a public payer), survival, and survival adjusted for disutility because of lost vision, for each strategy in the first year following treatment initiation. The expected first-year costs of treatment initiated with IVF, IVG and IVG-ORG were $US47,918, $US38,817 and $US32,036 (1994 values), respectively, while expected first-year survival was 41 weeks, 35 weeks and 35 weeks, respectively. The incremental cost per incremental year of survival using IVF was $US78,000 versus IVG and $US138,000 versus IVG-ORG before adjustment for lost vision, and $US93,000 versus IVG and $US166,000 versus IVG-ORG after adjustment for lost vision. About 23% of the cost of the IVG treatment strategy was attributable to treatment-related adverse events, compared with 14% of the cost of IVF and 16% of the cost of IVG-ORG. Because of the high failure rate with IVG-ORG, initial treatment with IVG-ORG frequently led to switching to another treatment. Only 27% of the costs associated with the IVG-ORG treatment strategy were in fact attributable to the cost of induction and maintenance therapy prior to a switch to alternative treatment. In this analysis, initial treatment with IVG-ORG was the least costly approach for treating CMV retinitis in patients with AIDS. Initial treatment with IVF resulted in slightly longer survival adjusted for vision-related quality of life. New treatments for AIDS may reduce the survival benefit of initial treatment with IVF. |
| spellingShingle | Griffiths, R Bleecker, G Jabs, D Dieterich, D Coleson, L Winters, D Wolitz, R Steinberg, E Pharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with AIDS. |
| title | Pharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with AIDS. |
| title_full | Pharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with AIDS. |
| title_fullStr | Pharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with AIDS. |
| title_full_unstemmed | Pharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with AIDS. |
| title_short | Pharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with AIDS. |
| title_sort | pharmacoeconomic analysis of 3 treatment strategies for cytomegalovirus retinitis in patients with aids |
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