Kn. Simpson, DESIGN AND ASSESSMENT OF COST-EFFECTIVENESS STUDIES IN AIDS POPULATIONS, Journal of acquired immune deficiency syndromes and human retrovirology, 10, 1995, pp. 28-32
Cost-effectiveness (CE) ratios are indicators of comparative efficienc
y of competing drugs. Unfortunately, they are subject to variations, d
epending on factors such as the study population chosen, the compariso
n treatment selected, and the economic analysis methods employed. CE r
atios tend to be unfavorably skewed in the case of chronic illnesses,
such as HIV disease, because management of AIDS patients is costly and
complex. Routine AIDS therapy requires expensive drugs, treatment is
directed at many disease stages and severities, and gain in patient su
rvival is relatively short. Variations in disease stage, co-morbiditie
s, and antiviral drug use produce variations in both the risk of oppor
tunistic infections (OIs) and the routine costs of OI prophylaxis and
thus affect the CE ratio. Routine therapy for AIDS varies among and ev
en within communities. Overall, these factors translate to a widening
gap between trial results (efficacy) and community outcomes (effective
ness). This article discusses these concerns and reviews methodologic
issues that must be considered by decision-makers using CE analyses to
describe a therapy's value.