A cost analysis of an internet based medication adherence intervention for people living with HIV

The introduction and widespread dissemination of combination antiretroviral therapy has dramatically changed the disease trajectory and life expectancy of people living with HIV (PLWH).1 Consistent adherence to antiretroviral medications can be difficult for patients to achieve, but non-adherence can have major costs to patients and healthcare payers.2-4 Face-to-face interventions to increase medication adherence are efficacious and cost effective when used by patients with moderate to high levels of non-adherence.5,6 Despite their effectiveness, a barrier to widespread implementation of face-to-face interventions to improve medication adherence is their costs. Computer-based and mobile phone technologies have been used to deliver medication adherence interventions and have been found to improve medication adherence7-11. A recent review of 36 studies of interventions, which utilized technology to improve HIV patient outcomes, showed interventions are most effective when they include easily usable, individually tailored, multifunctional adherence tools familiar to the patient, which do not alert others as to the purpose of the tool.12 Patients randomly assigned to a computer-administered adherence support intervention and who remained on protocol (i.e., did not discontinue treatment, and had regular exposure to the intervention) during the 18 month study period had greater three-day adherence than patients receiving standard care.13 In another study, patients randomized to receive a brief weekly adherence message on their mobile phones had significantly greater adherence at six and twelve months than patients receiving standard care.9,14 Online technologies are attractive as intervention delivery mechanisms because they easily blend into patient’s everyday lives and are accessible at times and places convenient to them. Once developed, technology-based interventions may be relatively inexpensive to implement and deliver via the internet. The costs of implementing technology-based interventions to improve antiretroviral medication adherence have received little attention, and we are unaware of any cost analysis of internet-based interventions. The purpose of the study was twofold: to document actual development costs of an internet social support and text message reminder intervention; and to estimate the costs of implementing the intervention from the perspective of an organization or insurance payer who might adopt and implement the intervention. Costs analyses of internet based interventions to improve medication adherence are important. As access to antiretroviral medications increases, studies of interventions to increase patient adherence are needed to ascertain their cost effectiveness, how widely the interventions can be implemented, and how sustainable the interventions might be once implemented.