Cost-effectiveness of baseline genotyping in the Netherlands David van de Vijver Dept. of virology, Erasmus Medical Centre Rotterdam

Introduction • There are no recent studies looking at the cost in relation to effects for baseline genotyping – Key study showing cost effectiveness published in 2001 • Weinstein et al. Ann Internal Med 2001

Changes during past decade • Novel drugs with higher genetic barrier • Treatment started at higher CD4 and lower viral loads • Frequent monitoring of HIV RNA plasma after treatment initiation – Timely identification of virological failure – Limited evolution of drug resistance mutations – Lower risk of clinical progression

Transmission of drug resistance • Prevalence is 10% in Europe • Impact of transmitted drug resistance – 5% are single TAMs – Transmission of protease inhibitor resistance is rare (