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Author Notes:

Correspondence: Raymond L Ownby; ro71@nova.edu

Authors' Contributions: RO designed the original study, obtained grant funding for its execution, completed data analyses, and wrote a draft of the original manuscript.

DW collaborated in the design of the original study, assisted in interpretation of data analyses, and assisted in the preparation of the manuscript.

RJ assisted in the development of the study intervention, assisted in completing the study, and helped to draft the manuscript.

AA provided assistance in data analyses and helped to draft the manuscript.

JC assisted in the development of the study intervention, assisted in completing the study, and helped to draft the manuscript.

All authors read and approved the final manuscript.

Acknowledgments: Rosemary Davenport, RN, MSN, ARNP, served as study coordinator for the parent study of the intervention described in this paper and provided essential support for the execution of the study.

Disclosures: The authors declare that they have no competing interests.


Research Funding:

Support for this study was provided by grant R21MH086491 to Dr. Ownby from the US National Institute on Mental Health. The funding body had no additional role in the design or execution of the study nor did it have a role in data analyses or the decision to submit the manuscript.

Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence


Journal Title:

BMC Medical Informatics and Decision Making


Volume 13, Number 29


, Pages 1-16

Type of Work:

Article | Final Publisher PDF


Background High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Clinician-delivered interventions can improve patients’ adherence, but usually require substantial effort by trained individuals and may not be widely available. Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet. We previously developed a computer-delivered intervention designed to improve patients’ level of health literacy as a strategy to improve their HIV medication adherence. The intervention was shown to increase patients’ adherence, but it was not clear that the benefits resulting from the increase in adherence could justify the costs of developing and deploying the intervention. The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention. Methods Costs of intervention development were drawn from accounting reports for the grant under which its development was supported, adjusted for costs primarily resulting from the project’s research purpose. Effectiveness of the intervention was drawn from results of the parent study. The relation of the intervention’s effects to changes in health status, expressed as utilities, was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years (QALYs). Sensitivity analyses evaluated ranges of possible intervention effectiveness and durations of its effects, and costs were evaluated over several deployment scenarios. Results The intervention’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness. Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for durations greater than three months and longer it was usually associated with a favorable cost per QALY. For intermediate and larger assumed effects and longer durations of intervention effectiveness, the intervention was associated with net cost savings. Conclusions Computer-delivered adherence interventions may be a cost-effective strategy to improve adherence in persons treated for HIV.

Copyright information:

© 2013 Ownby et al; licensee BioMed Central Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 2.0 Generic License (http://creativecommons.org/licenses/by/2.0/).

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