原创力文档cost-effectiveness of tenofovir instead of zidovudine for use in first-line antiretroviral therapy in settings without virological monitoring成本效益的泰诺福韦不是齐多夫定用于一线抗逆转录病毒疗法在设置病毒学监测.pdfVIP
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cost-effectiveness of tenofovir instead of zidovudine for use in first-line antiretroviral therapy in settings without virological monitoring成本效益的泰诺福韦不是齐多夫定用于一线抗逆转录病毒疗法在设置病毒学监测
Cost-Effectiveness of Tenofovir Instead of Zidovudine for
Use in First-Line Antiretroviral Therapy in Settings
without Virological Monitoring
1,2 1 3,4 3 5
Viktor von Wyl *, Valentina Cambiano , Michael R. Jordan , Silvia Bertagnolio , Alec Miners ,
6 7 1
Deenan Pillay , Jens Lundgren , Andrew N. Phillips
1 University College London, Research Department of Infection and Population Health, London, United Kingdom, 2 CSS Institute for Empirical Health Economics, Lucerne,
Switzerland, 3 World Health Organization, Geneva, Switzerland, 4 Tufts University, School of Medicine, Boston, Masschussetts, United States of America, 5 London School
of Hygiene and Tropical Medicine, London, United Kingdom, 6 University College London, Division of Infection and Immunity, London, United Kingdom, 7 Copenhagen
University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Abstract
Background: The most recent World Health Organization (WHO) antiretroviral treatment guidelines recommend the
inclusion of zidovudine (ZDV) or tenofovir (TDF) in first-line therapy. We conducted a cost-effectiveness analysis with
emphasis on emerging patterns of drug resistance upon treatment failure and their impact on second-line therapy.
Methods: We used a stochastic simulation of a generalized HIV-1 epidemic in sub-Saharan Africa to compare two strategies
for first-line combination antiretroviral treatment including lamivudine, nevirapine and either ZDV or TDF. Model input
parameters were derived from literature and, for the simulation of resistance pathways, estimated from drug resistance data
obtained
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