Extending PCP Prophylaxis in HIV-Infected Patients Proves Cost-Effective -- HIV/AIDS INFO AND UPDATES

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Date Posted: 12:19:55 05/16/02 Thu
Author: Anonymous
Subject: Extending PCP Prophylaxis in HIV-Infected Patients Proves Cost-Effective

http://www.medscape.com/viewarticle/432484_print

Extending PCP Prophylaxis in HIV-Infected Patients Proves Cost-Effective

Reuters Health Information 2002. � 2002 Reuters Ltd
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Introduction
NEW YORK (Reuters Health) Apr 23 - Continuing prophylaxis for Pneumocystis carinii pneumonia (PCP) in HIV-infected patients until CD4+ counts have rebounded to more than 300 cells/�L is a cost-effective measure for averting disease, investigators report in the Archives of Internal Medicine for April 22.

Dr. Sue J. Goldie, of the Harvard School of Public Health in Boston, and associates developed a computer-based simulation model to estimate the lifetime costs and quality-adjusted life expectancy associated with extending PCP prophylaxis in HIV-infected patients on highly active antiretroviral therapy.

Based on data from several clinical trials, nine cases of opportunistic infection per 1000 patients would be prevented by extending prophylaxis until patients reached >300 cells/�L, at a cost of $9400 per quality-adjusted life year. Even though this additional clinical benefit can be considered small, "the additional costs are so low that continued prophylaxis has an attractive cost-effectiveness ratio nonetheless," the authors write.

For patients intolerant of trimethoprim-sulfamethoxazole (TMP/SMX), switching to dapsone involved little additional cost. However, initiating treatment with atovaquone led to cost-effectiveness ratios of greater than $300,000 per quality-adjusted life year. Therefore, Dr. Goldie's group suggests, "using atovaquone before a trial of dapsone does not make policy sense."

Arch Intern Med 2002;162:921-928.

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