Document 0250
 DOCN  M9460250
 TI    A cost analysis of approved antiretroviral strategies in persons with
       advanced human immunodeficiency virus disease and zidovudine
       intolerance.
 DT    9404
 AU    Bozzette SA; Parker R; Hay J; Department of Medicine, University of
       California San Diego.
 SO    J Acquir Immune Defic Syndr. 1994 Apr;7(4):355-62. Unique Identifier :
       AIDSLINE MED/94180309
 AB    Treatment with zidovudine has been standard therapy for patients with
       advanced HIV infection, but intolerance is common. Previously,
       management of intolerance has consisted of symptomatic therapy, dose
       interruption/discontinuation, and, when appropriate, transfusion. The
       availability of new antiretroviral agents such as didanosine as well as
       adjunctive recombinant hematopoietic growth factors makes additional
       strategies possible for the zidovudine-intolerant patient. Because all
       of these agents are costly, we evaluated the cost implications of these
       various strategies for the management of zidovudine-intolerant
       individuals within a population of persons with advanced HIV disease. We
       performed a decision analysis using iterative algorithmic models of 1
       year of antiretroviral care under various strategies. The real costs
       providing antiretroviral therapy were estimated by deflating medical
       center charges by specific Medi-Cal (Medicaid) charge-to-payment ratios.
       Clinical data were extracted from the medical literature, product
       package inserts, investigator updates, and personal communications.
       Sensitivity analysis was used to test the effect of error in the
       estimation of parameters. The models predict that a strategy of dose
       interruption and transfusion for zidovudine intolerance will provide an
       average of 46 weeks of therapy per year to the average patient at a cost
       of $5,555/year of therapy provided (1991 U.S. dollars). The models
       predict that a strategy of adding hematopoietic growth factors to the
       regimen of appropriate patients would increase the average amount of
       therapy provided to the average patient by 3 weeks (6%) and the costs
       attributable to therapy by 77% to $9,805/year of therapy
       provided.(ABSTRACT TRUNCATED AT 250 WORDS)
 DE    Acquired Immunodeficiency Syndrome/DRUG THERAPY/ECONOMICS/THERAPY
       Agranulocytosis/CHEMICALLY INDUCED/THERAPY  Algorithms
       Anemia/CHEMICALLY INDUCED/THERAPY  Costs and Cost Analysis  Decision
       Support Techniques  Didanosine/ADVERSE EFFECTS/THERAPEUTIC USE
       Erythrocyte Transfusion  Erythropoietin/THERAPEUTIC USE  Granulocyte
       Colony-Stimulating Factor/THERAPEUTIC USE  Hematopoietic Cell Growth
       Factors/THERAPEUTIC USE  Human  HIV Infections/*DRUG
       THERAPY/*ECONOMICS/THERAPY  Pancreatitis/CHEMICALLY INDUCED  Quality of
       Life  Support, Non-U.S. Gov't  Support, U.S. Gov't, P.H.S.
       Zidovudine/ADVERSE EFFECTS/*THERAPEUTIC USE  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).