OBJECTIVES

: To assess the cost-effectiveness of using pharmacogenomic (PGx) testing techniques to reduce resistance-induced treatment failure among HIV patients on ART and compare the cost-effectiveness of PGx techniques in informing treatment-level decisions in treatment-naïve vs. treatment-experienced patients.

METHODS

: A literature search was conducted in PubMed, ProQuest and CINAHL databases using keywords: treatment, HIV, cost-effective, cost-benefit, genetic/genomic testing, germline/somatic variations and United States. The search identified all relevant articles published between 2006 and 2017 which included persons age 18 years and older that were mono-infected with HIV and underwent pharmacogenetic testing to inform the selection of HIV treatment. An assessment of article quality was completed independently by each researcher using the QHES guidelines with disagreements resolved via majority vote.

RESULTS

: The literature search returned 62 articles reporting on personalized medicine in the treatment of HIV/AIDS. Following hand search and researcher review, 8 articles were included for qualitative synthesis. Studies from this review evaluated the CE of genetic screening with and without HLA-B*5701 prior to initiating abacavir or tenofovir-based ART regimens. In the US, abacavir-based treatment with HLA-B*5701 has an ICER of $36,700 per QALY, while Tenofovir-based treatment increased costs without improving QALYs. In the US, genotype resistance testing at 1st-line ART failure has an ICER of $900 per YLS and increases life expectancy conditional to the prevalence of wild type virus and timely response to genotype results.

CONCLUSIONS

: Testing methods were stratified at the patient level (treatment-naïve vs. treatment-experienced) as these are the characteristics considered in treatment regimen selection. PGx testing proved to be cost-effective among both groups in comparison to non-genomic methods, yet issues remain regarding availability and ease of implementation in resource limited settings. Despite these concerns, this review indicates that employment of PGx testing in most settings would have long-term benefits economically and in terms of health gains.