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Budget Impacts of the Integration of Genotypic Antiretroviral Resistance Testing (GART) into HIV Treatment Guidelines K. N. SIMPSON*. Med. Univ. of South Carolina, Charleston Recent reports at international meetings (Chaix et al., Abstract # 466, I.C.A.A.C. San Francisco, September 26, 1999; Weinstein et al., Abstract # 86; Anis et al., Abstract #88, Society for Medical Decision Making, Reno, October 5, 1999) indicate that the use of GART to inform the choice of antiretroviral (ART) drugs after failure of a HAART regimen may be quite cost effective, and that GART has the potential for cost effectiveness when used to select HAART for ART-naïve patients in geographic areas where the prevalence of resistance is high. The authors differ in how they assess the economics of GART, as well as in the cost of testing and the distribution of cost savings and increases among cost categories. We developed a conceptual model which delineates nine types of costs which must be measured or estimated in order to adequately judge the cost effectiveness and budget impacts of including GART, phenotypic resistance tests (PRT), and/or ART drug levels (DLS) in ART treatment guidelines. Preliminary analyses (with data available as of October 1999) indicate that current estimates all leave potentially important cost factors out of their models. Furthermore, these estimates are subject to large fluctuations. We calculated the first-year budget impacts of the adoption of a guideline that specified using GART to inform ART in people on HAART whose viral load become detectable (after being initially suppressed) that cost savings, cost increases, or budget neutrality might be expected, depending on which study was used. Our most expensive estimate predicted an increase of $68 million, while the least expensive predicted a decrease of $77 million in expenditures to US treatment programs in the first year of such a guideline. The most likely estimate predicted budget neutrality with an increase in laboratory testing costs of $108 million, which was offset by savings on HAART of the same amount. Estimated lab cost increases (in US$) for eight European countries were: Austria $3 mil; France $43 mil; Germany $14 mil; Italy $35 mil; Netherlands $5 mil; Portugal $14 mil; Spain $47 mil; Switzerland $5 mil. Cost effectiveness ratios and budget impacts for other uses of GART, with and without the use of PRT or DLS, will also be discussed. Key Words: cost, guidelines, resistance testing |
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