A Comparison of the Clinical and Cost-Effectiveness of 3 Intervention Strategies for AIDS Wasting
Shevitz, A. H., Wilson, I. B., McDermott, A. Y., Spiegelman, D., Skinner, S. C., Antonsson, K., et al. (2005). A comparison of the clinical and cost-effectiveness of 3 intervention strategies for AIDS wasting. Journal of Acquired Immune Deficiency Syndrome, 38(4), 399-406.
Compare oxandrolone, an oral steroid hormone, with nutrition alone and nutrition plus strength training in order to treat muscle tissue wasting that occurs in people with AIDS.
Fifty patients with AIDS participated, with 47 completing the study. All subjects demonstrated a significant weight loss and/or a low body mass index (BMI).
Participants were randomized into 3 groups for 12 weeks: (1) Intensive nutrition intervention plus placebo pills (NA), (2) intensive nutrition intervention plus 10 mg of oxandrolone (OX) administered orally twice a day, or (3) intensive nutrition intervention plus progressive resistance training (PRT). This PRT involved 5 strength training exercises 3 times per week, with workloads progressively approaching 80% of the individual's 1-repetition maximum (1RM).
The subjects in the OX and PRT groups had increases in mid-thigh cross-sectional muscle area (CSMA), although these increases did not differ significantly from the group with nutrition alone. Only PRT caused significant improvements in physical functioning (PF) and 7 measures of strength. There were no overall differences between groups in change in PF. Among patients with impaired baseline PF, however, treatment with OX was significantly less effective than NA and PRT was significantly better than NA. All treatments led to increases in protein intake and performance; NA and PRT also increased caloric intake. The institutional costs per subject in this trial were $983 for NA, $3,772 for OX, and $3,189 for PRT. At a community-based level of intensity, the institutional costs per quality-adjusted life-years (QALY) were $45,000 for NA, $147,000 for OX, and $31,000 for PRT.
OX and PRT induce similar improvements in body composition, but PRT improves quality of life (including strength and PF) more than NA or OX, particularly among patients with impaired PF and with low risk of adverse effects. PRT was the most cost-effective intervention (which should encourage the interest of third-party payers), and oxandrolone (OX) was the least cost-effective intervention.