Featured Research

from universities, journals, and other organizations

Cost-effectiveness Of Genetic Screening To Guide Initial HIV Treatment Evaluated

Date:
September 23, 2008
Source:
New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College
Summary:
A major study from a team of researchers from Weill Cornell Medical College and Massachusetts General Hospital has found that a recent change to HIV-treatment guidelines recommending genetic screening is cost-effective under certain conditions.

A major study from a team of researchers from Weill Cornell Medical College and Massachusetts General Hospital has found that a recent change to HIV-treatment guidelines recommending genetic screening is cost-effective under certain conditions. The new recommendation suggests conducting a genetic screening test prior to prescribing the drug abacavir, one of the preferred first-line drugs for the treatment for HIV-infected adults.

Related Articles


"The guideline change represents one of the first situations in which a genetic test has been recommended for use in clinical practice to guide drug selection that will affect treatment decisions for thousands of patients each year," says lead author Dr. Bruce R. Schackman, associate professor of public health and chief of the Division of Health Policy in the Department of Public Health at Weill Cornell Medical College. "While the guidelines now recommend that physicians order this new test before prescribing abacavir, policy makers and insurers want to know whether the additional cost of the test is appropriate compared with not testing and using a different drug."

The study appears in the latest online issue of the journal AIDS.

The study findings provide guidance for policy makers in response to changes earlier this year in the U.S. Department of Health and Human Services' (DHHS) clinical guidelines for HIV treatment. A recent FDA-approved change in the abacavir drug label warns that it can cause a hypersensitivity reaction, especially in patients who carry a particular genetic variation (the HLA-B*5701 allele) that can be identified by the genetic test. Severe hypersensitivity reactions are very rare, but affect multiple organs and can be serious enough to cause hospitalization or death.

Dr. Schackman, Dr. Paul E. Sax, clinical director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital, and Dr. Kenneth A. Freedberg, director of Epidemiology and Outcomes Research at the Partners AIDS Research Center/Massachusetts General Hospital (PARC/MGH), collaborated on the study with Callie Scott and Drs. Rochelle P. Walensky and Elena Losina of PARC/MGH. Drs. Walensky and Losina are also affiliated with Brigham and Women's Hospital, and Drs. Freedberg and Losina are also affiliated with Boston University School of Public Health.

The authors determined that genetic testing for HLA-B*5701 is cost-effective, but only if abacavir-based treatment is as effective among those testing negative for the genetic variation as not testing and initiating treatment with tenofovir, another preferred first-line drug. In both cases, the drugs were assumed to be part of a "cocktail" that includes the drug efavirenz, which is commonly used in treating new HIV patients, and one other drug. Both abacavir and tenofovir are considered effective when used in this way, but no clinical trial results have been published that directly compare using these drugs in patients newly initiating HIV treatment. Separate "head-to-head" clinical trials that include this comparison are currently being conducted by the federally funded AIDS Clinical Trials Group and by GlaxoSmithKline, the manufacturer of abacavir.

Critically, genetic testing was found to be cost-effective based on published drug prices in the United States, where abacavir-based treatment costs less than tenofovir-based treatment, and based on Medicare reimbursement rates for the genetic test. Actual costs for drugs and tests vary by insurer and laboratory, and at lower tenofovir prices or higher test costs the genetic testing strategy was no longer cost-effective.

The authors used a computer simulation model to project the treatment outcomes and HIV medical care costs for patients initiating treatment with and without genetic testing. They used data from previous studies to project the likelihood of developing serious or mild side effects on each drug and substituting an alternative drug, and considered the implications of drug selections for subsequent HIV treatment decisions. Cost-effectiveness ratios were reported as cost per quality-adjusted life year.

"We found that genetic testing has a cost-effectiveness ratio of $36,700 per quality-adjusted life year," says Dr. Freedberg. "In the U.S., this cost-effectiveness ratio is below commonly accepted thresholds for medical interventions that are delivering ‘value for money.' In other words, based on available evidence, physicians using the test are making good decisions both for their individual patients and for society."

"With a negative result on the genetic screening test, both patient and physician can feel more confident about prescribing abacavir," says Dr. Sax. "This allows them to preserve alternative drugs as future options and can help save the health care system money by using a lower-priced drug."

The study was supported in part by the National Institute of Allergy and Infectious Diseases and the National Institute on Drug Abuse.


Story Source:

The above story is based on materials provided by New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College. Note: Materials may be edited for content and length.


Cite This Page:

New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College. "Cost-effectiveness Of Genetic Screening To Guide Initial HIV Treatment Evaluated." ScienceDaily. ScienceDaily, 23 September 2008. <www.sciencedaily.com/releases/2008/09/080917175242.htm>.
New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College. (2008, September 23). Cost-effectiveness Of Genetic Screening To Guide Initial HIV Treatment Evaluated. ScienceDaily. Retrieved October 31, 2014 from www.sciencedaily.com/releases/2008/09/080917175242.htm
New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College. "Cost-effectiveness Of Genetic Screening To Guide Initial HIV Treatment Evaluated." ScienceDaily. www.sciencedaily.com/releases/2008/09/080917175242.htm (accessed October 31, 2014).

Share This



More Health & Medicine News

Friday, October 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Melafind: Spotting Melanoma Without a Biopsy

Melafind: Spotting Melanoma Without a Biopsy

Ivanhoe (Oct. 31, 2014) The MelaFind device is a pain-free way to check suspicious moles for melanoma, without the need for a biopsy. Video provided by Ivanhoe
Powered by NewsLook.com
Battling Multiple Myeloma

Battling Multiple Myeloma

Ivanhoe (Oct. 31, 2014) The answer isn’t always found in new drugs – repurposing an ‘old’ drug that could mean better multiple myeloma treatment, and hope. Video provided by Ivanhoe
Powered by NewsLook.com
Chronic Inflammation and Prostate Cancer

Chronic Inflammation and Prostate Cancer

Ivanhoe (Oct. 31, 2014) New information that is linking chronic inflammation in the prostate and prostate cancer, which may help doctors and patients prevent cancer in the future. Video provided by Ivanhoe
Powered by NewsLook.com
Sickle Cell: Stopping Kids’ Silent Strokes

Sickle Cell: Stopping Kids’ Silent Strokes

Ivanhoe (Oct. 31, 2014) Blood transfusions are proving crucial to young sickle cell patients by helping prevent strokes, even when there is no outward sign of brain injury. Video provided by Ivanhoe
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins