Over the past 11 years, the """"""""Cost-Effectiveness of Preventing AIDS Complications"""""""" (CEPAC) team has expanded and refined its computer simulation of HIV disease in order to better address critical questions in HIV management. During the first two years ofthe R37 cycle, the CEPAC project has experienced tremendous growth, outstanding productivity, and increased outreach and collaboration with other NIAID-funded as well as other national and international research groups. During this time, the CEPAC team has published 19 peer-reviewed papers, with one more in press and two others submitted.
The specific aims for the next cycle of the grant (2010-2015) address critical areas of HIV clinical care and policy in the United States, while continuing the cutting-edge methodology and applications that have maintained the CEPAC team as an internationally-recognized HIV research effort. The three specific aims for the next phase of the grant are: 1. To examine the issue of when to start antiretroviral therapy in the US, taking into account a newer understanding of HIV disease complications and new approaches to HIV testing. 2. To determine the clinical impact, value and optimal use of both new diagnostic technologies and existing laboratory monitoring tests. 3. To evaluate comprehensive approaches to HIV care that will optimize treatment outcomes in the context of improved survival, an aging population, and an increasing prevalence of co-morbidities. During the next cycle of this project, we will use innovative simulation methods and incorporate new data from the best national sources to deliver high-impact studies that will directly influence HIV treatment guidelines and policies in the United States.

Public Health Relevance

The long-term management of HIV disease is increasingly complicated by development of non-HIV diseases and the high cost of HIV care, which includes not only medications, but also diagnostic tests and care over many years of therapy. Disease simulation modeling and cost-effectiveness analysisare invaluable tools for assessing the relative clinical benefits, costs and cost-effectiveness of HIV policies.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Method to Extend Research in Time (MERIT) Award (R37)
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Special Emphasis Panel (NSS)
Program Officer
Huebner, Robin E
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Massachusetts General Hospital
United States
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Girouard, Michael P; Sax, Paul E; Parker, Robert A et al. (2016) The Cost-effectiveness and Budget Impact of 2-Drug Dolutegravir-Lamivudine Regimens for the Treatment of HIV Infection in the United States. Clin Infect Dis 62:784-91
Schackman, Bruce R; Fleishman, John A; Su, Amanda E et al. (2015) The lifetime medical cost savings from preventing HIV in the United States. Med Care 53:293-301
Schackman, Bruce R; Leff, Jared A; Barter, Devra M et al. (2015) Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs. Addiction 110:129-43
Schackman, Bruce R; Haas, David W; Park, Sanghee S et al. (2015) Cost-effectiveness of CYP2B6 genotyping to optimize efavirenz dosing in HIV clinical practice. Pharmacogenomics 16:2007-18
Ross, Eric L; Weinstein, Milton C; Schackman, Bruce R et al. (2015) The clinical role and cost-effectiveness of long-acting antiretroviral therapy. Clin Infect Dis 60:1102-10
Pei, Pamela P; Weinstein, Milton C; Li, X Cynthia et al. (2015) Prioritizing HIV comparative effectiveness trials based on value of information: generic versus brand-name ART in the US. HIV Clin Trials 16:207-18
Linas, Benjamin P; Barter, Devra M; Morgan, Jake R et al. (2015) The cost-effectiveness of sofosbuvir-based regimens for treatment of hepatitis C virus genotype 2 or 3 infection. Ann Intern Med 162:619-29
Sax, Paul E; Sypek, Alexis; Berkowitz, Bethany K et al. (2014) HIV cure strategies: how good must they be to improve on current antiretroviral therapy? PLoS One 9:e113031
Linas, Benjamin P; Barter, Devra M; Leff, Jared A et al. (2014) The cost-effectiveness of improved hepatitis C virus therapies in HIV/hepatitis C virus coinfected patients. AIDS 28:365-76
McCormick, Alethea W; Abuelezam, Nadia N; Rhode, Erin R et al. (2014) Development, calibration and performance of an HIV transmission model incorporating natural history and behavioral patterns: application in South Africa. PLoS One 9:e98272

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