Cost-effectiveness analysis of tenofovir/emtricitabine and abacavir/lamivudine in combination with efavirenz or atazanavir/ritonavir for treatment-naïve adults with HIV-1 infection in the UK, based on the AIDS Clinical Trials Group 5202 clinical trial
| Autor: | Sandra E. Talbird, Elizabeth M. La, M Fisher, Anita Brogan, Edmund Wilkins |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Efavirenz Anti-HIV Agents Cost-Benefit Analysis HIV Infections Pharmacology Emtricitabine 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Abacavir Antiretroviral Therapy Highly Active Internal medicine medicine Humans Pharmacology (medical) 030212 general & internal medicine Clinical Trials as Topic business.industry 030503 health policy & services Health Policy Lamivudine Abacavir/Lamivudine Survival Analysis United Kingdom Atazanavir Clinical trial Treatment Outcome Infectious Diseases chemistry Ritonavir 0305 other medical science business medicine.drug |
| Zdroj: | HIV Medicine. 17:505-515 |
| ISSN: | 1464-2662 |
| DOI: | 10.1111/hiv.12349 |
| Popis: | Objectives The aim of the study was to assess the cost-effectiveness of the four regimens studied in the AIDS Clinical Trials Group (ACTG) 5202 clinical trial, tenofovir/emtricitabine (TDF/FTC) or abacavir/lamivudine (ABC/3TC) in combination with efavirenz (EFV) or atazanavir/ritonavir (ATV/r), for treatment-naive adults with HIV-1 infection in the UK. Methods A Markov model with six health states based on CD4 cell count ranges was developed to predict long-term costs and health outcomes for individuals on first-line therapy. Head-to-head efficacy data comparing TDF/FTC + EFV, TDF/FTC + ATV/r, ABC/3TC + EFV, and ABC/3TC + ATV/r were obtained from ACTG 5202 for up to 192 weeks. Antiretroviral drug costs were based on current list prices. Other medical costs (2013 UK pounds sterling), utility values, and mortality rates were obtained from published sources. Base-case, sensitivity, and subgroup analyses (by baseline viral load) were conducted. Results Individuals using TDF/FTC-based regimens were predicted to remain on first-line therapy longer and accrue more quality-adjusted life-years (QALYs) than individuals using ABC/3TC-based regimens. At a willingness-to-pay threshold of £30 000 per QALY gained, TDF/FTC-based regimens were predicted to be cost-effective compared with ABC/3TC-based regimens, with incremental cost-effectiveness ratios of £23 355 for TDF/FTC + EFV vs. ABC/3TC + EFV and £23 785 for TDF/FTC + ATV/r vs. ABC/3TC + ATV/r. Results were generally robust in subgroup, sensitivity, and scenario analyses. Conclusions In an analysis of the regimens studied in ACTG 5202 for treatment-naive adults with HIV-1 infection in the UK, TDF/FTC-based regimens yielded more favourable health outcomes and were generally predicted to be cost-effective compared with ABC/3TC-based regimens. These results confirm that TDF/FTC-based regimens are not only clinically effective but also cost-effective. |
| Databáze: | OpenAIRE |
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