Recent research has shown that CD4 monitoring may not be needed in clinically stable, virally suppressed HIV-infected patients, but new evidence goes further to show that there is potential for substantial savings by at least reducing this monitoring. According to a research letter published Oct. 14 in JAMA Internal Medicine, cutting CD4 monitoring from biannual to annual could result in up to $18 million of savings annually and up to $615 million over the lifetime of patient care. In 2013, guidelines for HIV care from the Department of Health and Human Services recommend CD4 monitoring every six to 12 months in clinically stable patients with suppressed viral load (no detectable HIV RNA in blood) while on anti-retroviral treatment. “I look at this ‘every 6 to 12 months’ frequency as a gentle way of trying to wean us off a monitoring strategy we have had now since the 1980s. Both patients and providers are so accustomed to regular CD4 monitoring that it seems too difficult to stop doing it cold turkey,” writes Paul Sax, M.D., Brigham and Women’s Hospital in Boston, in an editorial published inClinical Infectious Disease in May. Experts say that despite the recommendations, clinicians are still performing CD4 […]
Recent research has shown that CD4 monitoring may not be needed in clinically stable, virally suppressed HIV-infected patients, but new evidence goes further to show that there is potential for substantial savings by at least reducing this monitoring. According to a research letter published Oct. 14 in JAMA Internal Medicine, cutting CD4 monitoring from biannual to annual could result in up to $18 million of savings annually and up to $615 million over the lifetime of patient care.
In 2013, guidelines for HIV care from the Department of Health and Human Services recommend CD4 monitoring every six to 12 months in clinically stable patients with suppressed viral load (no detectable HIV RNA in blood) while on anti-retroviral treatment.
“I look at this ‘every 6 to 12 months’ frequency as a gentle way of trying to wean us off a monitoring strategy we have had now since the 1980s. Both patients and providers are so accustomed to regular CD4 monitoring that it seems too difficult to stop doing it cold turkey,” writes Paul Sax, M.D., Brigham and Women’s Hospital in Boston, in an editorial published inClinical Infectious Disease in May.
Experts say that despite the recommendations, clinicians are still performing CD4 monitoring tests more frequently—even quarterly—and that these CD4 results rarely, if ever, influence HIV clinical management. To calculate the economic impact of unnecessary CD4 monitoring, the researchers used $38 to $67 per test as the range of CD4 test costs range, depending on whether CD4 percentage is included. Additionally, they based calculations on a life expectancy of 22 to 34 years after HIV diagnosis. By reducing the current strategy of biannual CD4 monitoring to annual testing, annual savings range from $10.2 million to $18.1 million, with a population savings of $225.7 million to $615.1 million over the lifetime of patient care. Savings could be even greater in clinical practices that monitor more frequently.
“Our results likely underestimate the potential savings,” write the authors, led by Emily Hyle, M.D., from Massachusetts General Hospital in Boston. “The number of virologically suppressed patients with HIV is growing; as the population eligible for a reduced frequency of CD4 monitoring is increasing, so are the opportunities for savings.”
The authors emphasize that evidence shows that reducing CD4 monitoring frequency does not adversely affect health outcomes as CD4 counts rarely decline to clinically significant levels without a rise in HIV RNA levels.
“Even greater savings would occur if CD4 monitoring in stable patients were eliminated entirely, which warrants consideration,” concludes Hyle. “Given the still unmet medical needs of people living with HIV/AIDS, a recommendation for at most annual CD4 monitoring in stable, virologically suppressed patients offers a high value opportunity for a wise reinvestment of care.”
