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Updated: Apr 20, 2026
An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
Published on: March 30, 2014
Cost-effectiveness of genotype testing for primary resistance in Brazil
Paula M Luz1, Bethany L Morris, Beatriz Grinsztejn
1*Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; †Division of General Medicine, ‡The Medical Practice Evaluation Center, and the §Division of Infectious Disease, Massachusetts General Hospital, Boston, MA; ‖Harvard University Center for AIDS Research, Harvard Medical School, Boston, MA; ¶Department of Epidemiology, Boston University School of Public Health, Boston, MA; #Department of Health Policy and Management, Harvard School of Public Health, Boston, MA; **Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital, Boston, MA; ††Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; ‡‡Department of Biostatistics, Boston University School of Public Health, Boston, MA; and §§Yale School of Public Health, New Haven, CT.
Objective:
HIV genotype-resistance testing can help identify more effective antiretroviral treatment (ART) regimens for patients, substantially increasing the likelihood of viral suppression and immune recovery. We sought to evaluate the cost-effectiveness of genotype-resistance testing before first-line ART initiation in Brazil.
Design:
We used a previously published microsimulation model of HIV disease (CEPAC-International) and data from Brazil to compare the clinical impact, costs, and cost-effectiveness of initial genotype testing (Genotype) with no initial genotype testing (No genotype).
Methods:
Model parameters were derived from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute and from published data, using Brazilian sources whenever possible. Baseline patient characteristics included 69% male, mean age of 36 years (SD, 10 years), mean CD4 count of 347 per microliter (SD, 300/µL) at ART initiation, annual ART costs from 2012 US $1400 to US $13,400, genotype test cost of US $230, and primary resistance prevalence of 4.4%. Life expectancy and costs were discounted 3% per year. Genotype was defined as "cost-effective" compared with No Genotype if its incremental cost-effectiveness ratio was less than 3 times the 2012 Brazilian per capita GDP of US $12,300.
Results:
Compared with No genotype, Genotype increased life expectancy from 18.45 to 18.47 years and reduced lifetime cost from US $45,000 to $44,770; thus, in the base case, Genotype was cost saving. Genotype was cost-effective at primary resistance prevalence as low as 1.4% and remained cost-effective when subsequent-line ART costs decreased to 30% of baseline value. Cost-inefficient results were observed only when simultaneously holding multiple parameters to extremes of their plausible ranges.
Conclusions:
Genotype-resistance testing in ART-naive individuals in Brazil will improve survival and decrease costs and should be incorporated into HIV treatment guidelines in Brazil.
