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15-08-2006: BD (Becton, Dickinson and Company) announced the release of a study by researchers from the Johns Hopkins Bloomberg School of Public Health at the XVI International AIDS Conference (AIDS 2006) that demonstrated conducting CD4 tests is a cost-effective laboratory testing strategy for managing HIV infection in low income countries without access to second line antiretroviral treatment (ARV). The research was supported by a grant from BD Biosciences, a segment of BD.
The study compared the cost-effectiveness of CD4 counting to total lymphocyte count testing (TLC) and CD4 plus viral load (VL) testing. Monitoring CD4 counts allows caregivers to gauge the strength of patients' individual immune systems and better identify two very important sub-groups of HIV patients: those with an adequate CD4 count, but whose symptoms emulate advanced HIV infection; and those who appear well, but whose CD4 count shows that HIV disease has progressed to the point where ARV would be beneficial. When treatment is based on CD4 results, those patients whose CD4 counts are adequate are spared unnecessary treatments and their associated side effects, while those with low CD4 counts can be given an appropriate treatment regimen.
"The study results were surprising because they underscored how much can be saved by using CD4 tests to prevent unnecessary and costly treatment starts," said lead investigator David Bishai, M.D., Ph.D., MPH, Associate Professor, Department of Population and Family Health Services, Johns Hopkins Bloomberg School of Public Health. "We used a simulated population to represent the progression of HIV with and without treatment in sub-Saharan African populations. In the study, the savings found make up for the cost of testing in a population that acquired HIV between five and 10 years ago. The study also shows there are even more savings in less advanced patients."
The researchers utilized a mathematical simulation of HIV disease in a cohort of 10,000 virtual patients to assess the incremental impact and cost effectiveness of alternative laboratory monitoring strategies. For purposes of the study, they established a 10-year horizon that assessed outcomes as life years, quality adjusted life years, and costs from the societal perspective discounted at three percent. The study results demonstrated that adding CD4 testing saves additional lives with negligible changes in cost at only $635 per quality adjusted life year vs. $628 per quality adjusted life year in patients treated with ARV only and without CD4 testing to monitor disease progression.
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