Cost-effectiveness and Cost-utility of the Adherence Improving Self-management Strategy in Human Immunodeficiency Virus Care: A Trial-based Economic Evaluation

Ben F. M. Wijnen (Corresponding Author), Edwin J. M. Oberjé, Silvia M. A. A. Evers, Jan M. Prins, Hans-Erik Nobel, Cees van Nieuwkoop, Jan Veenstra, Frank J. Pijnappel, Frank P. Kroon, Laura van Zonneveld, Astrid G. W. Van Hulzen, Marjolein van Broekhuizen, Marijn de Bruin

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Objectives: Several promising HIV-treatment adherence interventions have been identified, but data about their cost-effectiveness is lacking. This study examines the trial-based cost-effectiveness and costutility of the proven-effective Adherence Improving self-Management Strategy (AIMS), from a societal
perspective, with 15 months’ time horizon.
Methods: Treatment-naïve, and treatment-experienced patients at-risk for viral rebound were randomized to treatment-as-usual (TAU) or AIMS in a multi-center randomized controlled trial, in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (two consecutive detectable viral loads), and qualityadjusted life years.
Results: 223 patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an ICER of €549 per reduction in log10 viral load and €1,659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of €27,759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU.
Conclusions: The base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a life-time horizon showing that AIMS is cost-effective.
Original languageEnglish
Pages (from-to)658-667
Number of pages10
JournalClinical Infectious Diseases
Issue number4
Early online date14 Sept 2018
Publication statusPublished - 15 Feb 2019

Bibliographical note

This study was funded by ZonMw (the Netherlands), program Doelmatigheidsonderzoek (grant number 171002208). This funding source had no role in study design, data collection, analysis, interpretation, or writing of the report. All authors declare that they have no competing interests.
We thank the HIV-nurses and physicians from the seven HIV-clinics who were involved in the AIMSstudy (Academic Medical Center, Amsterdam; Slotervaart Hospital, Amsterdam; St. Lucas-Andreas Hospital, Amsterdam; the Leiden University Medical Center, Leiden; Haga Teaching Hospital, Den Haag; Erasmus Medical Center, Rotterdam; Isala Clinics, Zwolle) for their input and collaboration. We also would like to express our gratitude to the study participants.
Written informed consent was obtained from each patient. The study has been approved by the ethics committee of each participating center.


  • adherence
  • intervention
  • cost effectiveness
  • cost-utility
  • Adherence
  • Intervention
  • Cost-effectiveness
  • Cost-utility
  • cost-effectiveness


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