The long‐term benefits of genotypic resistance testing in patients with extensive prior antiretroviral therapy: a model‐based approach

• Published in: HIV Medicine
• Main Authors: Yazdanpanah, Y, Vray, M, Meynard, J, Losina, E, Weinstein, MC, Morand‐Joubert, L, Goldie, SJ, Hsu, HE, Walensky, RP, Dalban, C, Sax, PE, Girard, PM, Freedberg, KA
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2007
• Subjects: narval
• Online Access: http://dx.doi.org/10.1111/j.1468-1293.2007.00491.x; https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fj.1468-1293.2007.00491.x; https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-1293.2007.00491.x

Objectives Resistance testing in HIV disease may provide long‐term benefits that are not evident from short‐term data. Our objectives were to estimate the long‐term effectiveness, cost and cost‐effectiveness of genotype testing in patients with extensive antiretroviral exposure. Methods We used an HIV simulation model to estimate the long‐term effectiveness and cost‐effectiveness of genotype testing. Clinical data incorporated into the model were from NARVAL, a randomized trial of resistance testing in patients with extensive antiretroviral exposure, and other randomized trials. Each simulated patient was eligible for up to three sequential regimens of antiretroviral therapy (i.e. two additional regimens beyond the trial‐based regimen) using drugs not available at the time of the study, such as lopinavir/ritonavir, darunavir/ritonavir and enfuvirtide. Results In the long term, projected undiscounted life expectancy increased from 132.2 months with clinical judgement alone to 147.9 months with genotype testing. Median survival was estimated at 11.9 years in the resistance testing arm vs 10.4 years in the clinical judgement alone arm. Because of increased survival, the projected lifetime discounted cost of genotype testing was greater than for clinical judgement alone (€313 900 vs €263 100; US$399 000 vs US$334 400). Genotype testing cost €69 600 (US$88 500) per quality‐adjusted life year gained compared with clinical judgement alone. Conclusions In patients with extensive prior antiretroviral exposure, genotype testing is likely to increase life expectancy in the long term as a result of the increased likelihood of receiving two active new drugs. Genotype testing is associated with cost‐effectiveness comparable to that of strategies accepted in patients with advanced HIV disease, such as enfuvirtide use.