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CD4 testing more cost effective, beneficial than viral load testing in Africa
Kahn JG. BMJ. 2011;doi:10.1136/bmj.d6884.
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Monitoring of routine CD4 cell count among HIV patients in a resource-limited setting was clinically and economically more desirable than routine viral load testing, according to new findings published in the British Medical Journal.
“Using CD4 cell counts to monitor antiretroviral therapy improved outcomes at a reasonable cost. Adding viral load levels in addition, adds little, if any clinical benefit, at a high cost,” James G. Kahn, of the University of California, San Francisco, told Infectious Disease News. “Thus, as we try to expand access to ART in poor settings, we should put money into the drugs and CD4 monitoring, and not viral load monitoring.”
Among HIV-infected patients undergoing ART with CD4 cell counts, 250 cells/mcL in Uganda, Africa, Kahn and colleagues examined the cost-effectiveness of three strategies, including clinical monitoring with quarterly CD4 cell counts and viral load measurement (clinical/CD4/viral load); clinical monitoring and quarterly CD4 counts (clinical/CD4); and clinical monitoring alone, according to the study.
The researchers calculated outcomes for the study period as well as future costs, disability adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs).
Compared with clinical monitoring alone, clinical/CD4 monitoring added $20,458 and averted 117.3 DALYs (ICER=$174 per DALY), whereas clinical/CD4/viral load monitoring increased costs by $142,458, and averted 27.5 DALYs ($5181 per DALY), according to the study.
Kahn said patients do well on ART, and a bit better with CD4 monitoring. “At least in our study, the only one in Africa, adding viral load provides no clinical benefit.”
“Standards in clinical practice well attuned to resource-rich settings might not maximize the opportunities available in resource-constrained settings,” Kahn and colleagues wrote in the study.
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