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Peter P. Sendi, Bruce A. Craig, Gabriela Meier, Dominik Pfluger, Amiram Gafni, Milos Opravil, Manuel Battegay, Heiner C. Bucher, the Swiss HIV Cohort Study, Cost-effectiveness of azithromycin for preventing Mycobacterium avium complex infection in HIV-positive patients in the era of highly active antiretroviral therapy, Journal of Antimicrobial Chemotherapy, Volume 44, Issue 6, December 1999, Pages 811–817, https://doi.org/10.1093/jac/44.6.811
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Abstract
We conducted a cost-effectiveness analysis to determine the clinical and economic consequences of Mycobacterium avium complex (MAC) prophylaxis in HIV-infected patients in the era of highly active antiretroviral therapy (HAART) in a health care system with access unrestricted by financial barriers. The analysis was performed from a health care perspective and compared azithromycin (1200 mg/week) with no prophylaxis over a period of 10 years based on data from the Swiss HIV Cohort Study (SHCS) and randomized controlled trials. The main outcome measures were: expected survival; average health care costs; and cost-effectiveness in 1997 Swiss francs (£1 corresponds to about 2.3 CHF) per life-year saved. In patients with an initial CD4 count <50 cells/mm3 and no AIDS, azithromycin increased expected survival by 4 months. In patients with AIDS, HAART durability had a major impact on expected survival and costs. Incremental survival increased from 2 to 4 months if we assumed a 10 year, instead of a 3 year, HAART effect. The cost-effectiveness of azithromycin relative to no prophylaxis in patients without AIDS was between 47,000 CHF (3-year HAART effect) and 60,000 CHF (10-year HAART effect) per life-year saved. The cost-effectiveness ratio increased to 118,000 CHF per life-year saved in patients with symptomatic AIDS. In conclusion, in the era of HAART, MAC prophylaxis with azithromycin increases expected survival and reduces health care costs substantially. Starting MAC prophylaxis in patients without AIDS is more effective and cost-effective than in patients with AIDS.
- acquired immunodeficiency syndrome
- azithromycin
- congestive heart failure
- antiretroviral therapy, highly active
- cost effectiveness
- cd4 count determination procedure
- health care costs
- hiv seropositivity
- mycobacterium avium complex
- mycobacterium avium-intracellulare infections
- economics
- hiv infections
- health care systems
- cost-effectiveness analysis
- swiss hiv cohort study
- outcome measures
- prevention