Differentiated HIV RNA viral load monitoring in resource-limited settings: an economic analysis. Clinical Infectious Diseases
Negoescu et al. developed a mathematical model using person-level longitudinal data to personalize decisions for timing of viral load monitoring. Moreover, they performed a cost-effectiveness analysis to inform the optimal monitoring interval in different resource contexts. The authors compared the cost-effectiveness of the personalized monitoring strategies to fixed monitoring intervals every 1, 3, 6, 12 and 24 months.
The authors found that shorter fixed viral load monitoring intervals yielded increasing benefits at increasing average costs. The adaptive policy optimized for low-income contexts achieved quality-adjusted life-years (QUALYs) and costs similar to the fixed 12-month policy. The adaptive policy optimized for middle-income resource settings yielded fewer QALYs per person, but saved costs compared to monitoring every three months.
In conclusion, focusing on patients most at risk of virologic failure improves the efficiency of viral load monitoring, most prominently in high-resource settings. The analysis suggests that in resource-limited settings monitoring at fixed 12-month intervals performs closely to the adaptive monitoring policies that define the cost-effectiveness frontier. Thus, monitoring at fixed 12-month intervals may be a good alternative to implement in resource-limited settings. In higher resource contexts, however, adaptive monitoring policies could lead to significant cost savings.