Active Surveillance versus Spontaneous Reporting for First-Line Antiretroviral Medicines in Namibia: A Cost–Utility Analysis

• Published in: Drug safety Vol. 39; no. 9; pp. 859 - 872
• Main Authors: Mann, Marita, Mengistu, Assegid, Gaeseb, Johannes, Sagwa, Evans, Mazibuko, Greatjoy, Babigumira, Joseph B., Garrison, Louis P., Stergachis, Andy
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2016; Springer Nature B.V
• Subjects: Acquired immune deficiency syndrome; Adult; Adverse Drug Reaction Reporting Systems - economics; AIDS; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - adverse effects; Antiretroviral agents; Antiretroviral Therapy, Highly Active - adverse effects; Antiretroviral Therapy, Highly Active - methods; Cohort analysis; Cohort Studies; Cost-Benefit Analysis; Costs; Drug Safety and Pharmacovigilance; Drug therapy; Ethics; Female; Health Care Costs - statistics & numerical data; HIV; HIV Infections - drug therapy; Hospitals; Human immunodeficiency virus; Humans; Lentivirus; Male; Medicine; Medicine & Public Health; Middle Aged; Namibia; Original Research Article; Pharmacology/Toxicology; Pharmacovigilance; Population; Public health; Quality of life; Quality-Adjusted Life Years; Retroviridae; Risk factors; Sentinel Surveillance; Studies; Surveillance; Namibia; Gross Domestic Product; Spontaneous Reporting System; Pharmacovigilance System; Spontaneous Reporting; Active Surveillance
• ISSN: 0114-5916; 1179-1942
• DOI: 10.1007/s40264-016-0432-y

Introduction
Active surveillance pharmacovigilance is a systematic approach to medicine safety assessment and health systems strengthening, but has not been widely implemented in low- and middle-income countries. This study aimed to assess the cost effectiveness of a national active surveillance pharmacovigilance system for highly active antiretroviral therapy (HAART) compared with the existing spontaneous reporting system in Namibia.
Methods
A cost–utility analysis from a governmental perspective compared active surveillance pharmacovigilance to spontaneous reporting. Data from a sentinel site active surveillance program in Namibia from August 2012 to April 2013 was projected to all HIV-infected adults initiating HAART in Namibia. Costs (pharmacovigilance program, HAART, adverse event [AE] treatment), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs, dollars/QALY) were evaluated. Analysis was completed for (i) cohort analysis: a single cohort beginning HAART in 1 year in Namibia followed over their remaining lifetime, and (ii) population analysis: patients continued to enter and leave care and treatment over 10 years.
Results
For the cohort analysis, totals were US$21,267,902 (2015 US dollars) and 116,224 QALYs for care and treatment under active surveillance pharmacovigilance versus US$15,257,381 and 116,122 QALYs for care and treatment under spontaneous reporting pharmacovigilance, resulting in an ICER of US$58,867/QALY for active surveillance compared with spontaneous reporting pharmacovigilance. The population analysis ICER was US$4989/QALY. Results were sensitive to quality of life associated with AEs.
Conclusion
Active surveillance pharmacovigilance was projected to be highly cost effective to improve treatment for HIV in Namibia. Active surveillance pharmacovigilance may be valuable to improve lives of HIV patients and more efficiently allocate health resources in Namibia.