EPICE-HIV: An Epidemiologic Cost-Effectiveness Model for HIV Treatment
Vandewalle, Björn (Exigo Consultores (Lisboa, Portugal))
Llibre Codina, Josep Maria (Institut Germans Trias i Pujol. Institut de Recerca de la Sida IrsiCaixa)
Parienti, Jean-Jacques (Côte de Nacre University Hospital (Caen, França))
Ustianowski, Andrew (North Manchester General Hospital)
Camacho, Ricardo (Catholic University of Leuven (Bèlgica))
Smith, Colette (University College London)
Miners, Alec (London School of Hygiene and Tropical Medicine))
Ferreira, Diana (Exigo Consultores (Lisboa, Portugal))
Félix, Jorge (Exigo Consultores (Lisboa, Portugal))

Fecha:	2016
Resumen:	The goal of this research was to establish a new and innovative framework for cost-effectiveness modeling of HIV-1 treatment, simultaneously considering both clinical and epidemiological outcomes. EPICE-HIV is a multi-paradigm model based on a within-host micro-simulation model for the disease progression of HIV-1 infected individuals and an agent-based sexual contact network (SCN) model for the transmission of HIV-1 infection. It includes HIV-1 viral dynamics, CD4+ T cell infection rates, and pharmacokinetics/pharmacodynamics modeling. Disease progression of HIV-1 infected individuals is driven by the interdependent changes in CD4+ T cell count, changes in plasma HIV-1 RNA, accumulation of resistance mutations and adherence to treatment. The two parts of the model are joined through a per-sexual-act and viral load dependent probability of disease transmission in HIV-discordant couples. Internal validity of the disease progression part of the model is assessed and external validity is demonstrated in comparison to the outcomes observed in the STaR randomized controlled clinical trial. We found that overall adherence to treatment and the resulting pattern of treatment interruptions are key drivers of HIV-1 treatment outcomes. Our model, though largely independent of efficacy data from RCT, was accurate in producing 96-week outcomes, qualitatively and quantitatively comparable to the ones observed in the STaR trial. We demonstrate that multi-paradigm micro-simulation modeling is a promising tool to generate evidence about optimal policy strategies in HIV-1 treatment, including treatment efficacy, HIV-1 transmission, and cost-effectiveness analysis.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	VIH (Virus) ; Tractament ; SIDA ; HIV-1 treatment ; Epidemiologic cost-effectiveness model
Publicado en:	PloS one, Vol. 11 Núm. 2 (February 2016) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0149007
PMID: 26870960

22 p, 834.8 KB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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