| Titre : | The cost-effectiveness of preventing AIDS-related opportunistic infections. (1998) |
| Auteurs : | K.A. FREEDBERG ; D.E. CRAVEN ; E. LOSINA ; A.D. PALTIEL ; J.A. SCHARFSTEIN ; Griii SEAGE ; M.C. WEINSTEIN ; Department of Epidemiology and Biostatistics. Boston University School of Public Health. Boston University School of Medicine. Boston. USA ; Department of Health Policy and Management. Harvard School of Public Health. Boston. USA ; Department of Medicine and Evans Medical Foundation. Boston Medical Center. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 279, n° 2, 1998) |
| Pagination : | 130-136 |
| Langues: | Anglais |
| Mots-clés : | Sida ; Virose ; Infection ; Champignon ; Bactérie ; Virus ; Toxoplasmose ; Parasitose ; Médicament antibiotique ; Médicament antiviral ; Analyse coût efficacité ; Economie santé ; Complication ; Prévention thérapeutique ; Homme ; Immunopathologie |
| Résumé : | [BDSP. Notice produite par INIST fcAbR0x0. Diffusion soumise à autorisation]. Context. - Multiple options are now available for prophylaxis of opportunistic infections related to the acquired immunodeficiency syndrome (AIDS). However, because of differences in incidence rates as well as drug efficacy, toxicity, and costs, the role of different types of prophylaxis remains uncertain. Objective. - To determine the clinical impact, cost, and cost-effectiveness of strategies for preventing opportunistic infections in patients with advanced human immunodeficiency virus (HIV) disease. Design. - We developed a Markov simulation model to compare different strategies for prophylaxis of Pneumocystis carinii pneumonia (PCP), toxoplasmosis, Mycobacterium avium complex (MAC) infection, fungal infections, and cytomegalovirus (CMV) disease in HIV-infected patients. Data for the model were derived from the Multicenter AIDS Cohort Study, randomized controlled trials, and the national AIDS Cost and Services Utilization Survey. Main Outcome Measures. - Projected life expectancy, quality-adjusted life expectancy, total lifetime direct medical costs, and cost-effectiveness in dollars per quality-adjusted life-year (QALY) saved. Results. - For patients with CD4 cell counts of 0.200 to 0.300x 109/L (200-300/muL) who receive no prophylaxis, we projected a quality-adjusted life expectancy of 39.08 months and average total lifetime costs of $40 288. Prophylaxis for PCP and toxoplasmosis with trimethoprim-sulfamethoxazole for patients with CD4 cell counts of 0. (...) |
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