Cost-Effectiveness of Juluca (dolutegravir/rilpivirine) for Human Immunodeficiency Virus (HIV-1) Infection Treatment in Virologically Suppressed Adults in Taiwan
| Autor: | Sara Lopes, Huang Tz Ou, Sarah Jane Anderson, Chun Ting Yang, Nai Ying Ko, Chiung Yuan Hsu |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Oncology
medicine.medical_specialty Efavirenz Cost effectiveness business.industry 030503 health policy & services Health Policy Cobicistat Economics Econometrics and Finance (miscellaneous) Emtricitabine Tenofovir alafenamide 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine chemistry Abacavir Rilpivirine Internal medicine Dolutegravir medicine 030212 general & internal medicine 0305 other medical science business Pharmacology Toxicology and Pharmaceutics (miscellaneous) medicine.drug |
| Zdroj: | Value in Health Regional Issues. 24:216-223 |
| ISSN: | 2212-1099 |
| DOI: | 10.1016/j.vhri.2020.11.010 |
| Popis: | Objectives Although the efficacy of traditional 3-drug regimens for the treatment of HIV is well established, tolerability and toxicity concerns remain. New 2-drug regimens such as Juluca (dolutegravir [DTG]/rilpivirine [RPV]) offer noninferior efficacy versus 3-drug regimens (SWORD-1 and SWORD-2 studies), while reducing cumulative drug exposure and potentially long-term toxicities and drug-drug interactions. Here, we assess the cost-effectiveness of DTG/RPV for the treatment of HIV-1 for virologically suppressed adults in Taiwan. Methods A hybrid decision tree and Markov cohort state transition model was used to evaluate the expected economic costs and clinical outcomes associated with DTG/RPV and comparators. Model health states were defined by viral load and CD4 cell count. Efficacy and safety data were informed from SWORD-1 and SWORD-2 studies and the literature. The risk of long-term toxicities (cardiovascular disease, bone fractures, and chronic kidney disease) were included. Current branded drug acquisition prices were included, and healthcare costs informed by a bespoke costing study using National Health Insurance Research Database data. Incremental cost-effectiveness ratios were calculated and compared with a willingness-to-pay threshold of 2 times Taiwan’s gross domestic product (NT$1 550 000). Results DTG/RPV was found to be a cost-saving regimen compared to 3 comparators (rilpivirine [RPV]/emtricitabine [FTC]/tenofovir disoproxil fumarate [TDF], dolutegravir [DTG]/abacavir [ABC]/lamivudine [3TC], and elvitegravir [EVG]/cobicistat [c]/emtricitabine [FTC]/tenofovir alafenamide [TAF]) and fell in the southwest quadrant of the cost-effectiveness plane where it is generating significant savings with a small decrement in lifetime quality-adjusted life-years (–0.005). It was, however, more expensive than efavirenz [EFV]/emtricitabine [FTC]/ tenofovir disoproxil fumarate [TDF]. Conclusions DTG/RPV is cost-saving compared to RPV/FTC/TDF, DTG/ABC/3TC, and EVG/c/FTC/TAF, and provides comparable efficacy with reduced cumulative drug exposure. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect