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  1. Cost-effectiveness of cytomegalovirus (CMV) disease prevention in patients with AIDS : oral ganciclovir and CMV polymerase chain reaction testing.

    Article - En anglais

    Objective 

    To perform a cost-effectiveness analysis of strategies to prevent cytomegalovirus (CMV) disease.

    Method 

    Markov model and published data.

    Patients 

    Hypothetical HIV-infected patients with CD4 cell counts<50 x 106/I and positive CMV serologies.

    Interventions 

    Oral ganciclovir daily versus plasma CMV DNA polymerase chain reaction (PCR) testing every 3 months with oral ganciclovir for patients with positive tests.

    Outcome measures 

    The number of CMV disease cases prevented by the interventions, life expectancy, disease-free life expectancy, and the cost to extend life by 1 year.

    Results 

    Oral ganciclovir preventive therapy reduces the lifetime number of CMV disease cases by 50 per 1000 cohort, extends life expectancy by 5 days and disease-free life expectancy by 18 days, and costs US$ 1762 517 per year of life extended.

    Periodic PCR testing reduces the lifetime number of CMV disease cases by eight per 1000 cohort, extends life expectancy by 1 day and disease-free life expectancy by 3 days, and costs US$ 495 158 per year of life extended.

    The prevention strategies could be acceptably cost effective only under a combination of optimistic assumptions and reduced costs.

    Conclusions 

    Oral ganciclovir preventive therapy and periodic plasma testing for CMV PCR with oral ganciclovir for those with positive tests result in small benefits at great cost.

    They are not cost-effective prevention strategies for persons with advanced HIV infection and positive CMV serologies.

    Mots-clés Pascal : SIDA, Virose, Infection, Cytomegalovirus humain, Betaherpesvirinae, Herpesviridae, Virus, Chimioprophylaxie, Dépistage, Analyse coût efficacité, Prévention, Homme, Voie orale, Réaction chaîne polymérase, Ganciclovir, Antiviral, Plasma sanguin, Exploration microbiologique, Nucléoside acyclique, Purine nucléoside, Immunopathologie, Immunodéficit, Economie santé

    Mots-clés Pascal anglais : AIDS, Viral disease, Infection, Human cytomegalovirus, Betaherpesvirinae, Herpesviridae, Virus, Chemoprophylaxis, Medical screening, Cost efficiency analysis, Prevention, Human, Oral administration, Polymerase chain reaction, Ganciclovir, Antiviral, Blood plasma, Microbiological investigation, Acyclic nucleoside, Purine nucleoside, Immunopathology, Immune deficiency, Health economy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0319353

    Code Inist : 002B06D01. Création : 12/09/1997.