COST-EFFECTIVENESS OF A NOVEL THERAPY TO PREVENT ADVANCED FRAILTY AMONG PEOPLE WITH HIV
Author(s)
Madison Dietl, BS1, Emily Hyle, MD, MSc2, Kristine Erlandson, MD, MSc3, Jordan Lake, MD, MSc4, Netanya Utay, MD5, Todd Brown, MD, PhD6, Kenneth Freedberg, MD, MSc2, Elena Losina, PhD1, Karen Smith, PhD1.
1Brigham & Women's Hospital, Boston, MA, USA, 2Division of Infectious Diseases and Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston, MA, USA, 3Department of Medicine, Division of Infectious Diseases, University of Colorado-Anschutz, Aurora, CO, USA, 4Department of Internal Medicine, University of Texas Health Science Center, Houston, TX, USA, 5Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA, 6Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
1Brigham & Women's Hospital, Boston, MA, USA, 2Division of Infectious Diseases and Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston, MA, USA, 3Department of Medicine, Division of Infectious Diseases, University of Colorado-Anschutz, Aurora, CO, USA, 4Department of Internal Medicine, University of Texas Health Science Center, Houston, TX, USA, 5Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA, 6Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
OBJECTIVES: People with HIV (PWH) experience frailty more frequently than people without HIV. Novel therapies and repurposed medications currently under investigation may prevent frailty. To inform value-based pricing, we identified combinations of efficacy and costs under which a novel therapy to prevent advanced frailty in PWH would be cost-effective.
METHODS: We used a microsimulation model of frailty with parameters derived from longitudinal studies of PWH (the ACTG A5322 study and the MACS/WIHS Combined Cohort Study (MWCCS)) and published literature. PWH faced annual probabilities of worsening/improving frailty and transitioned between states defined by Fried Frailty Phenotype characteristics: non-frailty (0-2 characteristics), frailty (3 characteristics), and advanced frailty (4-5 characteristics). We also considered scenarios where people with advanced frailty cannot recover to less advanced frailty. We defined base-case therapy efficacy as a 40% reduction in transitions to worsened frailty states (similar to effects sizes from exercise programs). We used a healthcare sector perspective and 3% annual discount rate. We identified the annual cost at which the therapy would be cost-effective (<$100,000/quality-adjusted life-year (QALY)) and conducted deterministic and probabilistic sensitivity analyses.
RESULTS: At 40% efficacy, a therapy to prevent advanced frailty would increase quality-adjusted life-expectancy by 0.3 QALYs and be cost-effective at ≤$1,000/year. In sensitivity analyses, the therapy would be cost-effective at costs ranging from ≤$500/year (20% efficacy) to ≤$1,500/year (60% efficacy). In the “no recovery from advanced frailty” scenario, the therapy would increase quality-adjusted life-expectancy by 0.5 QALYs and be cost-effective at ≤$2,500/year (40% efficacy), ≤$1,000/year (20% efficacy), or ≤$3,500/year (60% efficacy). At $1,000/year, the therapy would be cost-effective in 52% of base-case simulations and 99% of simulations without recovery from advanced frailty.
CONCLUSIONS: A low cost (≤$1,000/year) therapy to prevent advanced frailty for PWH could be cost-effective with 40% efficacy. Higher cost therapies (≤$3,500/year) could be cost-effective for PWH who do not recover from advanced frailty.
METHODS: We used a microsimulation model of frailty with parameters derived from longitudinal studies of PWH (the ACTG A5322 study and the MACS/WIHS Combined Cohort Study (MWCCS)) and published literature. PWH faced annual probabilities of worsening/improving frailty and transitioned between states defined by Fried Frailty Phenotype characteristics: non-frailty (0-2 characteristics), frailty (3 characteristics), and advanced frailty (4-5 characteristics). We also considered scenarios where people with advanced frailty cannot recover to less advanced frailty. We defined base-case therapy efficacy as a 40% reduction in transitions to worsened frailty states (similar to effects sizes from exercise programs). We used a healthcare sector perspective and 3% annual discount rate. We identified the annual cost at which the therapy would be cost-effective (<$100,000/quality-adjusted life-year (QALY)) and conducted deterministic and probabilistic sensitivity analyses.
RESULTS: At 40% efficacy, a therapy to prevent advanced frailty would increase quality-adjusted life-expectancy by 0.3 QALYs and be cost-effective at ≤$1,000/year. In sensitivity analyses, the therapy would be cost-effective at costs ranging from ≤$500/year (20% efficacy) to ≤$1,500/year (60% efficacy). In the “no recovery from advanced frailty” scenario, the therapy would increase quality-adjusted life-expectancy by 0.5 QALYs and be cost-effective at ≤$2,500/year (40% efficacy), ≤$1,000/year (20% efficacy), or ≤$3,500/year (60% efficacy). At $1,000/year, the therapy would be cost-effective in 52% of base-case simulations and 99% of simulations without recovery from advanced frailty.
CONCLUSIONS: A low cost (≤$1,000/year) therapy to prevent advanced frailty for PWH could be cost-effective with 40% efficacy. Higher cost therapies (≤$3,500/year) could be cost-effective for PWH who do not recover from advanced frailty.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE336
Topic
Economic Evaluation
Disease
SDC: Geriatrics, SDC: Infectious Disease (non-vaccine), SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)