Open Access Highly Accessed Research article

Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence

Raymond L Ownby1*, Drenna Waldrop-Valverde2, Robin J Jacobs1, Amarilis Acevedo3 and Joshua Caballero4

Author affiliations

1 Department of Psychiatry and Behavioral Medicine, Room 1477, Nova Southeastern University, Fort Lauderdale, FL 33316, USA

2 Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA

3 Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL, USA

4 College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, USA

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Citation and License

BMC Medical Informatics and Decision Making 2013, 13:29  doi:10.1186/1472-6947-13-29

Published: 28 February 2013

Abstract

Background

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. 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.

Methods

Costs 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.

Results

The 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.

Conclusions

Computer-delivered adherence interventions may be a cost-effective strategy to improve adherence in persons treated for HIV.

Trial registration

Clinicaltrials.gov identifier NCT01304186.

Keywords:
HIV; Cost effectiveness analysis; QALY; Computer intervention; Medication adherence