News & Events

Abstract#: MOPE0680 
Presentation Date: Monday, 14 August 2006
Location: Exhibition Area, Level 800, South Building of MTCC

BD (Becton, Dickinson and Company) announced today the release of a study by researchers from the Johns Hopkins Bloomberg School of Public Health at the XVI International AIDS Conference (AIDS 2006) that demonstrated conducting CD4 tests is a cost-effective laboratory testing strategy for managing HIV infection in low income countries without access to second line antiretroviral treatment (ARV). The research was supported by a grant from BD Biosciences, a segment of BD.

The study compared the cost-effectiveness of CD4 counting to total lymphocyte count testing (TLC) and CD4 plus viral load (VL) testing. Monitoring CD4 counts allows caregivers to gauge the strength of patients’ individual immune systems and better identify two very important sub-groups of HIV patients: those with an adequate CD4 count, but whose symptoms emulate advanced HIV infection; and those who appear well, but whose CD4 count shows that HIV disease has progressed to the point where ARV would be beneficial. When treatment is based on CD4 results, those patients whose CD4 counts are adequate are spared unnecessary treatments and their associated side effects, while those with low CD4 counts can be given an appropriate treatment regimen.

“The study results were surprising because they underscored how much can be saved by using CD4 tests to prevent unnecessary and costly treatment starts,” said lead investigator David Bishai, M.D., Ph.D., MPH, Associate Professor, Department of Population and Family Health Services, Johns Hopkins Bloomberg School of Public Health. “We used a simulated population to represent the progression of HIV with and without treatment in sub-Saharan African populations. In the study, the savings found make up for the cost of testing in a population that acquired HIV between five and 10 years ago. The study also shows there are even more savings in less advanced patients.”

The researchers utilized a mathematical simulation of HIV disease in a cohort of 10,000 virtual patients to assess the incremental impact and cost effectiveness of alternative laboratory monitoring strategies. For purposes of the study, they established a 10-year horizon that assessed outcomes as life years, quality adjusted life years, and costs from the societal perspective discounted at three percent. The study results demonstrated that adding CD4 testing saves additional lives with negligible changes in cost at only $635 per quality adjusted life year vs. $628 per quality adjusted life year in patients treated with ARV only and without CD4 testing to monitor disease progression. The abstract can be found at http://www.aids2006.org/mainpage.aspx?pageId=265.

Four monitoring strategies were compared:

Syndromic management without lab test (ARV only)
• Syndromic management plus total lymphocyte counts every six months (TLC)
• Syndromic management plus CD4 tests every six months (CD4)
• Syndromic management plus CD4 plus VL testing four weeks after the initiation of treatment, then every six months (VL)

“We hope that this study will help decision-makers in developing countries as they determine their strategies for combating AIDS,” said Dr. Bishai. “Cost-effectiveness alone will not be the only decision factor in formulating health policy, but this study supports the idea that in the absence of second line treatments, CD4 testing would offset costs by limiting the use of that therapy in patients who don’t need it. It also demonstrates that even with the presence of costly second line treatments, CD4 and VL tests would enhance the selection of cases for treatment.”

A similar study designed to examine the cost effectiveness of tuberculosis (TB) diagnostics currently underway at Johns Hopkins Bloomberg School of Public Health also was funded by BD. TB is the most common infection and leading cause of death among people living with HIV. Of the estimated 14 million people co-infected with TB/HIV, 10 million reside in Africa.

About BD

BD, a leading global medical technology company that makes and sells medical devices, instrumented systems and reagents, is dedicated to improving people’s health throughout the world. BD is focused on improving drug therapy, enhancing the quality and speed of diagnosing infectious diseases, and advancing research and discovery of new drugs and vaccines. The Company’s capabilities are instrumental in combating many of the world’s most pressing diseases. Founded in 1897 and headquartered in Franklin Lakes, New Jersey, BD employs more than 25,000 people in approximately 50 countries throughout the world. The Company serves healthcare institutions, life science researchers, clinical laboratories, industry and the general public. For more information, please visit www.bd.com.