Abstract
We have read with interest the work of Shevitz and colleagues entitled ‘‘A Comparison of the Clinical and Cost-Effectiveness of 3 Intervention Strategies for AIDS Wasting’’ published in the April 1 2005 issue. Their objective was to compare nutrition alone (NA) with oxandrolone plus nutrition (OX) or progressive resistance training plus nutrition (PRT) for AIDS wasting. They conclude that OX and PRT induce similar improvements in body composition but that PRT improves quality of life (QOL) more than NA or OX particularly among patients with impaired physical function (PF). They further conclude that PRT was the most cost-effective intervention whereas OX was the least. We applaud the authors’ attempt to present health economics data for an area that has largely been neglected. Moreover the issue of managing or preventing wasting in AIDS is pertinent given its impact on patients’ outcome and QOL. Based on our understanding and research work in this area however we have serious questions regarding the study design and more significantly the methodology that the authors used to arrive at cost per quality-adjusted life-years (QALYs). Ultimately we view their ‘‘societal perspective’’ cost utility analysis conclusion as seriously flawed. (excerpt)
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