Skip to main content

Advertisement

SpringerLink
Log in

Determining the Cost-Savings Threshold for HIV Adherence Intervention Studies for Persons with Serious Mental Illness and HIV

  • Brief Communication
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Persons with serious mental illnesses are at increased risk for contracting and transmitting HIV and often have poor adherence to medication regimens. Determining the economic feasibility of different HIV adherence interventions among individuals with HIV and serious mental illness is important for program planners who must make resource allocation decisions. The goal of this study was to provide a methodology to estimate potential cost savings from an HIV medication adherence intervention program for a new study population, using data from prior published studies. The novelty of this approach is the way CD4 count data was used as a biological marker to estimate costs averted by greater adherence to anti-retroviral treatment. Our approach is meant to be used in other adherence intervention studies requiring cost modeling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  • Arici, C., Ripamonti, D., Ravasio, V., Maggiolo, F., Rizzi, M., Finazzi, M. G., & Suter, F. (2001). Long-term clinical benefit after highly active antiretroviral therapy in advanced HIV-1 infection, even in patients without immune reconstitution. International journal of STD and AIDS, 12(9), 573–581.

    Article  CAS  PubMed  Google Scholar 

  • Blank, M. B., & Eisenberg, M. M. (2013). Tailored treatment for HIV+ persons with mental illness: the intervention cascade. Journal of Acquired Immune Deficiency Syndromes, 63, S44–S48.

    Article  PubMed  PubMed Central  Google Scholar 

  • Blank, M. B., Hanrahan, N. P., Fishbein, M., Wu, E. S., Tennille, J. A., Ten Have, T. R., … & Aiken, L. H. (2011). A randomized trial of a nursing intervention for HIV disease management among persons with serious mental illness. Psychiatric Services, 62(11), 1318–1324.

  • Blank, M. B., Mandell, D. S., Aiken, L., & Hadley, T. R. (2002). Co-occurrence of HIV and serious mental illness among Medicaid recipients. Psychiatric Services, 53(7), 868–873.

    Article  PubMed  Google Scholar 

  • Chen, R. Y., Accortt, N. A., Westfall, A. O., Mugavero, M. J., Raper, J. L., Cloud, G. A., … & Saag, M. S. (2006). Distribution of health care expenditures for HIV-infected patients. Clinical Infectious Diseases, 42(7), 1003–1010.

  • Crabtree-Ramírez, B., Villasís-Keever, A., Galindo-Fraga, A., del Río, C., & Sierra-Madero, J. (2010). Effectiveness of highly active antiretroviral therapy (HAART) among HIV-infected patients in Mexico. AIDS Research and Human Retroviruses, 26(4), 373–378.

    Article  PubMed  PubMed Central  Google Scholar 

  • Descamps, D., Flandre, P., Calvez, V., Peytavin, G., Meiffredy, V., Collin, G., … & Brun-Vézinet, F. (2000). Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of induction-maintenance therapy. JAMA, 283(2), 205–211.

  • Freedberg, K. A., Losina, E., Weinstein, M. C., Paltiel, A. D., Cohen, C. J., Seage, G. R., … & Goldie, S. J. (2001). The cost effectiveness of combination antiretroviral therapy for HIV disease. New England Journal of Medicine, 344(11), 824–831.

  • Gebo, K. A., Chaisson, R. E., Folkemer, J. G., Bartlett, J. G., & Moore, R. D. (1999). Costs of HIV medical care in the era of highly active antiretroviral therapy. Aids, 13(8), 963–969.

    Article  CAS  PubMed  Google Scholar 

  • Gibellini, D., Borderi, M., De Crignis, E., Cicola, R., Cimatti, L., Vitone, F., … & Re, M. C. (2008). HIV-1 DNA load analysis in peripheral blood lymphocytes and monocytes from naive and HAART-treated individuals. Journal of Infection, 56(3), 219–225.

  • Gross, R., Bilker, W. B., Friedman, H. M., & Strom, B. L. (2001). Effect of adherence to newly initiated antiretroviral therapy on plasma viral load. Aids, 15(16), 2109–2117.

    Article  CAS  PubMed  Google Scholar 

  • Halkitis, P., & Kirton, C. (1999). Self-strategies as means of enhancing adherence to HIV antiretroviral therapies: A Rogerian approach. Journal-New York State Nurses Association, 30(2), 22–27.

    Google Scholar 

  • Hamet, J. H., Cheng, D. M., Libman, H., Nunes, D. P., Alperen, J. K., & Saitz, R. (2007). Alcohol consumption and HIV disease progression. Journal of Acquired Immune Deficiency Syndromes (1999), 46(2), 194.

    Article  Google Scholar 

  • Hanrahan, N. P., Wu, E., Kelly, D., Aiken, L. H., & Blank, M. B. (2011). Randomized clinical trial of the effectiveness of a home-based advanced practice psychiatric nurse intervention: outcomes for individuals with serious mental illness and HIV. Nursing Research and Practice, 2011. doi:10.1155/2011/840248.

  • Hart, J. E., Jeon, C. Y., Ivers, L. C., Behforouz, H. L., Caldas, A., Drobac, P. C., & Shin, S. S. (2010). Effect of directly observed therapy for highly active antiretroviral therapy on virologic, immunologic, and adherence outcomes: A meta-analysis and systematic review. Journal of Acquired Immune Deficiency Syndromes, 54(2), 167–179.

    PubMed  PubMed Central  Google Scholar 

  • Himelhoch, S., Brown, C. H., Walkup, J., Chander, G., Korthius, P. T., Afful, J., & Gebo, K. A. (2009). HIV patients with psychiatric disorders are less likely to discontinue HAART. Aids, 23(13), 1735–1742.

    Article  PubMed  PubMed Central  Google Scholar 

  • Holtgrave, D. R. (2007). Costs and consequences of the US centers for disease control and prevention’s recommendations for opt-out HIV testing. PLoS Medicine, 4(6), e194.

    Article  PubMed  PubMed Central  Google Scholar 

  • Holtgrave, D. R., Briddell, K., Little, E., Bendixen, A. V., Hooper, M., Kidder, D. P., … & Aidala, A. (2007). Cost and threshold analysis of housing as an HIV prevention intervention. AIDS and Behavior, 11(2), 162–166.

  • Holtgrave, D. R., Hall, H. I., Wehrmeyer, L., & Maulsby, C. (2012). Costs, consequences and feasibility of strategies for achieving the goals of the national HIV/AIDS strategy in the United States: A closing window for success? AIDS and Behavior, 16(6), 1365–1372.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C. (2013) Foundations and Principles. HIV Treatments as Prevention (TasP) (pp. 1–29). New York: Springer.

  • Krentz, H., Auld, M., & Gill, M. (2004). The high cost of medical care for patients who present late (CD4 <200 cells/μL) with HIV infection. HIV Medicine, 5(2), 93–98.

    Article  CAS  PubMed  Google Scholar 

  • Le Pen, C., Rozenbaum, W., Downs, A., Maurel, F., Lilliu, H., & Brun, C. (2001). Effect of HAART on health status and hospital costs of severe HIV-infected patients: A modeling approach. HIV Clinical Trials, 2(2), 136–145.

    Article  PubMed  Google Scholar 

  • Marseille, E., Kahn, J. G., Pitter, C., Bunnell, R., Epalatai, W., Jawe, E., … & Mermin, J. (2009). The cost effectiveness of home-based provision of antiretroviral therapy in rural Uganda. Applied Health Economics and Health Policy, 7(4), 229–243.

  • Mayer, K., Gazzard, B., Zuniga, J. M., Amico, K. R., Anderson, J., Azad, Y., … & Sow, P. S. (2013). Controlling the HIV epidemic with antiretrovirals IAPAC consensus statement on treatment as prevention and preexposure prophylaxis. Journal of the International Association of Providers of AIDS Care, 12(3), 208–216.

  • Olsen, C. H., Gatell, J., Ledergerber, B., Katlama, C., Friis-Møller, N., Weber, J., … & EuroSIDA Study Group. (2005). Risk of AIDS and death at given HIV-RNA and CD4 cell count, in relation to specific antiretroviral drugs in the regimen. Aids, 19(3), 319–330.

  • Paltiel, A. D., Freedberg, K. A., Scott, C. A., Schackman, B. R., Losina, E., Wang, B., … & Walensky, R. P. (2009). HIV preexposure prophylaxis in the United States: Impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clinical Infectious Diseases, 48(6), 806–815.

  • Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., … & Singh, N. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133(1), 21–30.

  • Reynolds, N. R., Testa, M. A., Marc, L. G., Chesney, M. A., Neidig, J. L., Smith, S. R., … & Robbins, G. K. (2004). Factors influencing medication adherence beliefs and self-efficacy in persons naive to antiretroviral therapy: A multicenter, cross-sectional study. AIDS and Behavior, 8(2), 141–150.

  • Rosenberg, S. D., Goodman, L. A., Osher, F. C., Swartz, M. S., Essock, S. M., Butterfield, M. I., … & Salyers, M. P. (2001). Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. American Journal of Public Health, 91(1), 31–37.

  • Rothbard, A. B., Metraux, S., & Blank, M. B. (2003). Cost of care for medicaid recipients with serious mental illness and HIV infection or AIDS. Psychiatric Services, 54(9), 1240–1246.

    Article  PubMed  Google Scholar 

  • Rothbard, A. B., Miller, K., Lee, S., & Blank, M. (2009). Revised cost estimates of medicaid recipients with serious mental illness and HIV-AIDS. Psychiatric Services, 60(7), 974–977.

    Article  PubMed  Google Scholar 

  • Safren, S. A., Otto, M. W., Worth, J. L., Salomon, E., Johnson, W., Mayer, K., & Boswell, S. (2001). Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behaviour Research and Therapy, 10, 1151–1162.

    Article  Google Scholar 

  • Samet, J. H., Horton, N. J., Meli, S., Freedberg, K. A., & Palepu, A. (2004). Alcohol consumption and antiretroviral adherence among HIV-infected persons with alcohol problems. Alcoholism: Clinical and Experimental Research, 28(4), 572–577.

    Article  CAS  Google Scholar 

  • Schackman, B. R., Gebo, K. A., Walensky, R. P., Losina, E., Muccio, T., Sax, P. E., … & Freedberg, K. A. (2006). The lifetime cost of current human immunodeficiency virus care in the United States. Medical Care, 44(11), 990–997.

  • Susser, E., Valencia, E., & Conover, S. (1993). Prevalence of HIV-infection among psychiatric patients in a Nwe York City men’s shelter. American Journal of Public Health, 83(4), 568–570.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Trentacoste, N. D., Holtgrave, D. R., Collins, C., & Abdul-Quader, A. (2004). Disseminating effective behavioral interventions for HIV prevention: a cost analysis of a risk-reduction intervention for drug users. Journal of Public Health Management and Practice, 10(2), 130–139.

    Article  PubMed  Google Scholar 

  • Tuldra, A., Ferrer, M. J., Fumaz, C. R., Bayes, R., Paredes, R., Burger, D. M., & Clotet, B. (1999). Monitoring adherence to HIV therapy. Archives of Internal Medicine, 159(12), 1376.

    Article  CAS  PubMed  Google Scholar 

  • Wagner, G. J., Kanouse, D. E., Koegel, P., & Sullivan, G. (2003). Adherence to HIV antiretrovirals among persons with serious mental illness. AIDS Patient Care and STDs, 17(4), 179–186.

    Article  PubMed  Google Scholar 

  • Wainberg, M. A., & Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. The Journal of the American Medical Association, 279(24), 1977–1983.

    Article  CAS  PubMed  Google Scholar 

  • Walkup, J., Blank, M. B., Gonzalez, J. S., Safren, S., Schwartz, R., Brown, L., … & Schumacher, J. E. (2008). The impact of mental health and substance abuse factors on HIV prevention and treatment. JAIDS Journal of Acquired Immune Deficiency Syndromes, 47, S15–S19.

  • Walkup, J., Crystal, S., & Sambamoorthi, U. (1999). Schizophrenia and major affective disorder among medicaid recipients with HIV AIDS in New Jersey. American Journal of Public Health, 89(7), 1101–1103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Walkup, J., Satriano, J., Barry, D., Sadler, P., & Cournos, F. (2002). HIV testing policy and serious mental illness. American Journal of Public Health, 92(12), 1931–1940.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This research was supported by grants from National Institute on Drug Abuse (RO1-DA-015627 ‘‘HIV Prevention Program among Substance Abusing SMI”) and the National Institute for Nursing Research (RO1-NR-008851 ‘‘Nursing Intervention for HIV Regimen: Adherence among SMI’’). Trial registration: clinicaltrials.gov identifier NCT00264823.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market Street, #3103, Philadelphia, PA, 19104, USA

    Evan S. Wu, Aileen Rothbard & Michael B. Blank

  2. Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Aileen Rothbard & Michael B. Blank

  3. School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA

    Aileen Rothbard

  4. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MA, USA

    David R. Holtgrave

  5. Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA

    Michael B. Blank

Authors
  1. Evan S. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aileen Rothbard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David R. Holtgrave
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael B. Blank
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael B. Blank.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, E.S., Rothbard, A., Holtgrave, D.R. et al. Determining the Cost-Savings Threshold for HIV Adherence Intervention Studies for Persons with Serious Mental Illness and HIV. Community Ment Health J 52, 439–445 (2016). https://doi.org/10.1007/s10597-014-9788-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-014-9788-6

Keywords

Search

Navigation