Practice guidelines recommending Mycobacterium avium complex (MAC) prophylaxis for patients with HIV disease were based on clinical trials in which individuals did not receive protease inhibitors.
To estimate the cost-effectiveness of strategies for MAC prophylaxis in patients whose treatment regimen includes protease inhibitors.
Decision analysis with Markov modelling of the natural history of advanced HIV disease.
Five strategies were evaluated : no prophylaxis, azithromycin, rifabutin, clarithromycin and a combination of azithromycin plus rifabutin.
Survival, quality of life, quality-adjusted survival, health care costs and marginal cost-effectiveness ratios.
Compared with no prophylaxis, rifabutin increased life expectancy from 78 to 80 months, increased quality-adjusted life expectancy from 50 to 52 quality-adjusted months and increased health care costs from $233 000 to $239 800.
Ignoring time discounting and quality of life, the cost-effectiveness of rifabutin relative to no prophylaxis was $44 300 per life year.
Adjusting for time discounting and quality of life, the cost-effectiveness of rifabutin relative to no prophylaxis was $41 500 per quality-adjusted life year (QALY).
In comparison with rifabutin, azithromycin was associated with increased survival, increased costs and an incremental cost-effectiveness ratio of $54 300 per QALY. (...)
Mots-clés Pascal : SIDA, Virose, Infection, Infection opportuniste, Complication, Mycobactériose, Bactériose, Mycobacterium avium, Mycobacteriaceae, Mycobacteriales, Actinomycetes, Bactérie, Complexe espèces, Rifabutine, Chimioprophylaxie, Antibactérien, Azithromycine, Clarithromycine, Analyse coût efficacité, Survie, Qualité vie, Coût, Pronostic, Homme, Macrolide, Immunopathologie, Immunodéficit, Economie santé
Mots-clés Pascal anglais : AIDS, Viral disease, Infection, Opportunistic infection, Complication, Mycobacterial infection, Bacteriosis, Mycobacterium avium, Mycobacteriaceae, Mycobacteriales, Actinomycetes, Bacteria, Species complex, Rifabutin, Chemoprophylaxis, Antibacterial agent, Azithromycin, Clarithromycin, Cost efficiency analysis, Survival, Quality of life, Costs, Prognosis, Human, Macrolide, Immunopathology, Immune deficiency, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0420418
Code Inist : 002B02S05. Création : 25/01/1999.