Cost-Effectiveness and Cost-Utility of the Adherence Improving self-Management Strategy (AIMS) in HIV-Care: A Trial-Based Economic Evaluation

Ben F. M. Wijnen (Corresponding Author), Edwin J. M. Oberjé, Silvia M. A. A. Evers, Jan M. Prins, Hans-Erik Nobel, Cees van Nieuwkoop, Jan Veenstra, Frank J. Pijnappel, Frank P. Kroon, Laura van Zonneveld, Astrid G. W. Van Hulzen, Marjolein van Broekhuizen, Marijn de Bruin

Research output: Contribution to journalArticle

Abstract

Objectives: Several promising HIV-treatment adherence interventions have been identified, but data about their cost-effectiveness is lacking. This study examines the trial-based cost-effectiveness and costutility of the proven-effective Adherence Improving self-Management Strategy (AIMS), from a societal
perspective, with 15 months’ time horizon.
Methods: Treatment-naïve, and treatment-experienced patients at-risk for viral rebound were randomized to treatment-as-usual (TAU) or AIMS in a multi-center randomized controlled trial, in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (two consecutive detectable viral loads), and qualityadjusted life years.
Results: 223 patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an ICER of €549 per reduction in log10 viral load and €1,659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of €27,759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU.
Conclusions: The base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a life-time horizon showing that AIMS is cost-effective.
Original languageEnglish
Pages (from-to)658-667
Number of pages10
JournalClinical Infectious Diseases
Volume68
Issue number4
Early online date14 Sep 2018
DOIs
Publication statusPublished - 1 Feb 2019

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Self Care
Cost-Benefit Analysis
HIV
Costs and Cost Analysis
Quality-Adjusted Life Years
Viral Load
Therapeutics
Treatment Failure
Netherlands
Randomized Controlled Trials
Nurses
Delivery of Health Care

Keywords

  • adherence
  • intervention
  • HIV/AIDS
  • cost effectiveness
  • cost-utility
  • Adherence
  • Intervention
  • Cost-effectiveness
  • Cost-utility
  • VIRAL LOAD
  • cost-effectiveness
  • MULTICENTER
  • FORM HEALTH SURVEY
  • TREATMENT OUTCOMES
  • HIV-INFECTED PATIENTS
  • INTERVENTIONS
  • ACTIVE ANTIRETROVIRAL THERAPY
  • NONADHERENCE
  • QUESTIONNAIRE
  • MEDICATION ADHERENCE

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Cost-Effectiveness and Cost-Utility of the Adherence Improving self-Management Strategy (AIMS) in HIV-Care : A Trial-Based Economic Evaluation. / Wijnen, Ben F. M. (Corresponding Author); Oberjé, Edwin J. M.; Evers, Silvia M. A. A.; Prins, Jan M.; Nobel, Hans-Erik; van Nieuwkoop, Cees ; Veenstra, Jan; Pijnappel, Frank J.; Kroon, Frank P.; van Zonneveld, Laura ; Van Hulzen, Astrid G. W.; van Broekhuizen, Marjolein; de Bruin, Marijn.

In: Clinical Infectious Diseases, Vol. 68, No. 4, 01.02.2019, p. 658-667.

Research output: Contribution to journalArticle

Wijnen, BFM, Oberjé, EJM, Evers, SMAA, Prins, JM, Nobel, H-E, van Nieuwkoop, C, Veenstra, J, Pijnappel, FJ, Kroon, FP, van Zonneveld, L, Van Hulzen, AGW, van Broekhuizen, M & de Bruin, M 2019, 'Cost-Effectiveness and Cost-Utility of the Adherence Improving self-Management Strategy (AIMS) in HIV-Care: A Trial-Based Economic Evaluation' Clinical Infectious Diseases, vol. 68, no. 4, pp. 658-667. https://doi.org/10.1093/cid/ciy553
Wijnen, Ben F. M. ; Oberjé, Edwin J. M. ; Evers, Silvia M. A. A. ; Prins, Jan M. ; Nobel, Hans-Erik ; van Nieuwkoop, Cees ; Veenstra, Jan ; Pijnappel, Frank J. ; Kroon, Frank P. ; van Zonneveld, Laura ; Van Hulzen, Astrid G. W. ; van Broekhuizen, Marjolein ; de Bruin, Marijn. / Cost-Effectiveness and Cost-Utility of the Adherence Improving self-Management Strategy (AIMS) in HIV-Care : A Trial-Based Economic Evaluation. In: Clinical Infectious Diseases. 2019 ; Vol. 68, No. 4. pp. 658-667.
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abstract = "Objectives: Several promising HIV-treatment adherence interventions have been identified, but data about their cost-effectiveness is lacking. This study examines the trial-based cost-effectiveness and costutility of the proven-effective Adherence Improving self-Management Strategy (AIMS), from a societalperspective, with 15 months’ time horizon.Methods: Treatment-na{\"i}ve, and treatment-experienced patients at-risk for viral rebound were randomized to treatment-as-usual (TAU) or AIMS in a multi-center randomized controlled trial, in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (two consecutive detectable viral loads), and qualityadjusted life years.Results: 223 patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an ICER of €549 per reduction in log10 viral load and €1,659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of €27,759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU.Conclusions: The base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a life-time horizon showing that AIMS is cost-effective.",
keywords = "adherence, intervention, HIV/AIDS, cost effectiveness, cost-utility, Adherence, Intervention, Cost-effectiveness, Cost-utility, VIRAL LOAD, cost-effectiveness, MULTICENTER, FORM HEALTH SURVEY, TREATMENT OUTCOMES, HIV-INFECTED PATIENTS, INTERVENTIONS, ACTIVE ANTIRETROVIRAL THERAPY, NONADHERENCE, QUESTIONNAIRE, MEDICATION ADHERENCE",
author = "Wijnen, {Ben F. M.} and Oberj{\'e}, {Edwin J. M.} and Evers, {Silvia M. A. A.} and Prins, {Jan M.} and Hans-Erik Nobel and {van Nieuwkoop}, Cees and Jan Veenstra and Pijnappel, {Frank J.} and Kroon, {Frank P.} and {van Zonneveld}, Laura and {Van Hulzen}, {Astrid G. W.} and {van Broekhuizen}, Marjolein and {de Bruin}, Marijn",
note = "This study was funded by ZonMw (the Netherlands), program Doelmatigheidsonderzoek (grant number 171002208). This funding source had no role in study design, data collection, analysis, interpretation, or writing of the report. All authors declare that they have no competing interests. We thank the HIV-nurses and physicians from the seven HIV-clinics who were involved in the AIMSstudy (Academic Medical Center, Amsterdam; Slotervaart Hospital, Amsterdam; St. Lucas-Andreas Hospital, Amsterdam; the Leiden University Medical Center, Leiden; Haga Teaching Hospital, Den Haag; Erasmus Medical Center, Rotterdam; Isala Clinics, Zwolle) for their input and collaboration. We also would like to express our gratitude to the study participants. Written informed consent was obtained from each patient. The study has been approved by the ethics committee of each participating center.",
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T1 - Cost-Effectiveness and Cost-Utility of the Adherence Improving self-Management Strategy (AIMS) in HIV-Care

T2 - A Trial-Based Economic Evaluation

AU - Wijnen, Ben F. M.

AU - Oberjé, Edwin J. M.

AU - Evers, Silvia M. A. A.

AU - Prins, Jan M.

AU - Nobel, Hans-Erik

AU - van Nieuwkoop, Cees

AU - Veenstra, Jan

AU - Pijnappel, Frank J.

AU - Kroon, Frank P.

AU - van Zonneveld, Laura

AU - Van Hulzen, Astrid G. W.

AU - van Broekhuizen, Marjolein

AU - de Bruin, Marijn

N1 - This study was funded by ZonMw (the Netherlands), program Doelmatigheidsonderzoek (grant number 171002208). This funding source had no role in study design, data collection, analysis, interpretation, or writing of the report. All authors declare that they have no competing interests. We thank the HIV-nurses and physicians from the seven HIV-clinics who were involved in the AIMSstudy (Academic Medical Center, Amsterdam; Slotervaart Hospital, Amsterdam; St. Lucas-Andreas Hospital, Amsterdam; the Leiden University Medical Center, Leiden; Haga Teaching Hospital, Den Haag; Erasmus Medical Center, Rotterdam; Isala Clinics, Zwolle) for their input and collaboration. We also would like to express our gratitude to the study participants. Written informed consent was obtained from each patient. The study has been approved by the ethics committee of each participating center.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objectives: Several promising HIV-treatment adherence interventions have been identified, but data about their cost-effectiveness is lacking. This study examines the trial-based cost-effectiveness and costutility of the proven-effective Adherence Improving self-Management Strategy (AIMS), from a societalperspective, with 15 months’ time horizon.Methods: Treatment-naïve, and treatment-experienced patients at-risk for viral rebound were randomized to treatment-as-usual (TAU) or AIMS in a multi-center randomized controlled trial, in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (two consecutive detectable viral loads), and qualityadjusted life years.Results: 223 patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an ICER of €549 per reduction in log10 viral load and €1,659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of €27,759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU.Conclusions: The base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a life-time horizon showing that AIMS is cost-effective.

AB - Objectives: Several promising HIV-treatment adherence interventions have been identified, but data about their cost-effectiveness is lacking. This study examines the trial-based cost-effectiveness and costutility of the proven-effective Adherence Improving self-Management Strategy (AIMS), from a societalperspective, with 15 months’ time horizon.Methods: Treatment-naïve, and treatment-experienced patients at-risk for viral rebound were randomized to treatment-as-usual (TAU) or AIMS in a multi-center randomized controlled trial, in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (two consecutive detectable viral loads), and qualityadjusted life years.Results: 223 patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an ICER of €549 per reduction in log10 viral load and €1,659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of €27,759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU.Conclusions: The base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a life-time horizon showing that AIMS is cost-effective.

KW - adherence

KW - intervention

KW - HIV/AIDS

KW - cost effectiveness

KW - cost-utility

KW - Adherence

KW - Intervention

KW - Cost-effectiveness

KW - Cost-utility

KW - VIRAL LOAD

KW - cost-effectiveness

KW - MULTICENTER

KW - FORM HEALTH SURVEY

KW - TREATMENT OUTCOMES

KW - HIV-INFECTED PATIENTS

KW - INTERVENTIONS

KW - ACTIVE ANTIRETROVIRAL THERAPY

KW - NONADHERENCE

KW - QUESTIONNAIRE

KW - MEDICATION ADHERENCE

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DO - 10.1093/cid/ciy553

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JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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