Health State Utilities of Risks Associated with Antiretroviral Treatment for Human Immunodeficiency Virus (HIV)

L. S. Matza; K. C. Chung; K. J. Kim; Trena M. Paulus; E. W. Davies; K. D. Stewart; G. A. McComsey; M. Fordyce

doi:10.1016/j.jval.2015.09.1517

Health State Utilities of Risks Associated with Antiretroviral Treatment for Human Immunodeficiency Virus (HIV)

L. S. Matza
, K. C. Chung
, K. J. Kim
, Trena M. Paulus
, E. W. Davies
, K. D. Stewart
, G. A. McComsey
, M. Fordyce

Evidera, Bethesda, MD
Gilead Sciences
University of Georgia
Evidera, London, UK
Case Western Reserve University

Research output: Contribution to journal › Article › peer-review

Abstract

 Objectives
 People with human immunodeficiency virus (HIV) have increased risk of cardiovascular disease (CVD), kidney disease, and low bone mineral density. Some antiretroviral therapies (ART) further increase the risk of these events. The purpose of this study was to estimate health state utilities associated with these risks so that the values may be used in cost-utility models.
 
 Methods
 Qualitative thematic analysis was conducted to examine 4,122 messages posted to the POZ/AIDSmeds Internet Community Forums from 2008 to 2014. This analysis assessed member awareness of, concerns about, and treatment changes due to bone, kidney, and heart-related side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off (TTO) interviews with general population participants in the UK (London, Edinburgh).
 
 Results
 Quantitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6y). The mean (SD) utility of the basic HIV health state (describing a virologically suppressed patient treated with ART) was 0.86 (0.14). Adding a description of risk to this basic health state was associated with statistically significant disutility (i.e., utility decreases): risk of renal problems (disutility = -0.02), risk of bone problems (-0.03), and risk of myocardial infarction (-0.05). Health states including the medical conditions themselves, rather than risk, had larger disutilities (e.g., stage 4 chronic kidney disease; disutility = -0.19).
 
 Conclusions
 The vignette-based TTO method was feasible for quantifying the utility impact of ART-related risks, demonstrating small but consistent disutilities. These disutilities may be used in cost-utility models comparing the value of treatments for patients with HIV.

Original language	American English
Journal	Value in Health
Volume	18
DOIs	https://doi.org/10.1016/j.jval.2015.09.1517
State	Published - Nov 1 2015
Externally published	Yes

Keywords

Human Immunodeficiency Virus
antiretroviral treatment
associated risks
health risks

Disciplines

Alternative and Complementary Medicine
Family Medicine
Medicine and Health Sciences
Critical Care

Access to Document

10.1016/j.jval.2015.09.1517License: Unspecified

PIIS1098301515035937.pdfFinal published version, 52.7 KBLicense: Unspecified

Cite this

@article{7c420ff82a014ff78e1fc1592963738f,

title = "Health State Utilities of Risks Associated with Antiretroviral Treatment for Human Immunodeficiency Virus (HIV)",

abstract = " Objectives People with human immunodeficiency virus (HIV) have increased risk of cardiovascular disease (CVD), kidney disease, and low bone mineral density. Some antiretroviral therapies (ART) further increase the risk of these events. The purpose of this study was to estimate health state utilities associated with these risks so that the values may be used in cost-utility models. Methods Qualitative thematic analysis was conducted to examine 4,122 messages posted to the POZ/AIDSmeds Internet Community Forums from 2008 to 2014. This analysis assessed member awareness of, concerns about, and treatment changes due to bone, kidney, and heart-related side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off (TTO) interviews with general population participants in the UK (London, Edinburgh). Results Quantitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4\% female; mean age 44.6y). The mean (SD) utility of the basic HIV health state (describing a virologically suppressed patient treated with ART) was 0.86 (0.14). Adding a description of risk to this basic health state was associated with statistically significant disutility (i.e., utility decreases): risk of renal problems (disutility = -0.02), risk of bone problems (-0.03), and risk of myocardial infarction (-0.05). Health states including the medical conditions themselves, rather than risk, had larger disutilities (e.g., stage 4 chronic kidney disease; disutility = -0.19). Conclusions The vignette-based TTO method was feasible for quantifying the utility impact of ART-related risks, demonstrating small but consistent disutilities. These disutilities may be used in cost-utility models comparing the value of treatments for patients with HIV.",

keywords = "Human Immunodeficiency Virus, antiretroviral treatment, associated risks, health risks",

author = "Matza, \{L. S.\} and Chung, \{K. C.\} and Kim, \{K. J.\} and Paulus, \{Trena M.\} and Davies, \{E. W.\} and Stewart, \{K. D.\} and McComsey, \{G. A.\} and M. Fordyce",

year = "2015",

month = nov,

day = "1",

doi = "10.1016/j.jval.2015.09.1517",

language = "American English",

volume = "18",

journal = "Value in Health",

}

TY - JOUR

T1 - Health State Utilities of Risks Associated with Antiretroviral Treatment for Human Immunodeficiency Virus (HIV)

AU - Matza, L. S.

AU - Chung, K. C.

AU - Kim, K. J.

AU - Paulus, Trena M.

AU - Davies, E. W.

AU - Stewart, K. D.

AU - McComsey, G. A.

AU - Fordyce, M.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Objectives People with human immunodeficiency virus (HIV) have increased risk of cardiovascular disease (CVD), kidney disease, and low bone mineral density. Some antiretroviral therapies (ART) further increase the risk of these events. The purpose of this study was to estimate health state utilities associated with these risks so that the values may be used in cost-utility models. Methods Qualitative thematic analysis was conducted to examine 4,122 messages posted to the POZ/AIDSmeds Internet Community Forums from 2008 to 2014. This analysis assessed member awareness of, concerns about, and treatment changes due to bone, kidney, and heart-related side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off (TTO) interviews with general population participants in the UK (London, Edinburgh). Results Quantitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6y). The mean (SD) utility of the basic HIV health state (describing a virologically suppressed patient treated with ART) was 0.86 (0.14). Adding a description of risk to this basic health state was associated with statistically significant disutility (i.e., utility decreases): risk of renal problems (disutility = -0.02), risk of bone problems (-0.03), and risk of myocardial infarction (-0.05). Health states including the medical conditions themselves, rather than risk, had larger disutilities (e.g., stage 4 chronic kidney disease; disutility = -0.19). Conclusions The vignette-based TTO method was feasible for quantifying the utility impact of ART-related risks, demonstrating small but consistent disutilities. These disutilities may be used in cost-utility models comparing the value of treatments for patients with HIV.

AB - Objectives People with human immunodeficiency virus (HIV) have increased risk of cardiovascular disease (CVD), kidney disease, and low bone mineral density. Some antiretroviral therapies (ART) further increase the risk of these events. The purpose of this study was to estimate health state utilities associated with these risks so that the values may be used in cost-utility models. Methods Qualitative thematic analysis was conducted to examine 4,122 messages posted to the POZ/AIDSmeds Internet Community Forums from 2008 to 2014. This analysis assessed member awareness of, concerns about, and treatment changes due to bone, kidney, and heart-related side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off (TTO) interviews with general population participants in the UK (London, Edinburgh). Results Quantitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6y). The mean (SD) utility of the basic HIV health state (describing a virologically suppressed patient treated with ART) was 0.86 (0.14). Adding a description of risk to this basic health state was associated with statistically significant disutility (i.e., utility decreases): risk of renal problems (disutility = -0.02), risk of bone problems (-0.03), and risk of myocardial infarction (-0.05). Health states including the medical conditions themselves, rather than risk, had larger disutilities (e.g., stage 4 chronic kidney disease; disutility = -0.19). Conclusions The vignette-based TTO method was feasible for quantifying the utility impact of ART-related risks, demonstrating small but consistent disutilities. These disutilities may be used in cost-utility models comparing the value of treatments for patients with HIV.

KW - Human Immunodeficiency Virus

KW - antiretroviral treatment

KW - associated risks

KW - health risks

U2 - 10.1016/j.jval.2015.09.1517

DO - 10.1016/j.jval.2015.09.1517

M3 - Article

VL - 18

JO - Value in Health

JF - Value in Health

ER -