Abstract
BackgroundHigh levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Clinician-delivered interventions can improve patients’ adherence, but usually require substantial effort by trained individuals and may not be widely available. Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet. We previously developed a computer-delivered intervention designed to improve patients’ level of health literacy as a strategy to improve their HIV medication adherence. The intervention was shown to increase patients’ adherence, but it was not clear that the benefits resulting from the increase in adherence could justify the costs of developing and deploying the intervention. The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention.MethodsCosts of intervention development were drawn from accounting reports for the grant under which its development was supported, adjusted for costs primarily resulting from the project’s research purpose. Effectiveness of the intervention was drawn from results of the parent study. The relation of the intervention’s effects to changes in health status, expressed as utilities, was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years (QALYs). Sensitivity analyses evaluated ranges of possible intervention effectiveness and durations of its effects, and costs were evaluated over several deployment scenarios.ResultsThe intervention’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness. Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for durations greater than three months and longer it was usually associated with a favorable cost per QALY. For intermediate and larger assumed effects and longer durations of intervention effectiveness, the intervention was associated with net cost savings.ConclusionsComputer-delivered adherence interventions may be a cost-effective strategy to improve adherence in persons treated for HIV.Trial registrationClinicaltrials.gov identifier NCT01304186.
Highlights
High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels
Studies of medication adherence in persons treated for HIV infection, show that many affected individuals do not achieve the levels of adherence needed for optimal treatment outcomes [1,2]
As the effect of the intervention was assumed to persist for six months, deployment cost calculations are based on this period
Summary
High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Social psychological theories of health behavior have been used to develop interventions to promote adherence, and many have been successful Theories such as Information-Motivation-Behavioral Skills model, [3] the Health Belief Model, [4] and the Theory of Planned Behavior [5] as well as empirical research on factors associated with poor adherence have been the basis for various effective interventions [6,7]. It is likely that a great deal of clinician-delivered adherence counseling is delivered in the context of hurried clinical visits during which other medical concerns must be addressed [11] This strategy may be less than optimal, especially in light of research that has shown that patients may remember as little as little as 50% of orally-presented information [12,13] and that memory for information provided by clinicians is related to age, education, and gender [14].
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