Lopinavir/Ritonavir Versus Darunavir Plus Ritonavir for HIV Infection: A Cost-Effectiveness Analysis for the United States
Autor: | Kristen Migliaccio-Walle, Jörgen Möller, Kit N. Simpson, William C. Woodward, J. Jaime Caro, Pamela P. Pei, Robert W. Baran, Birgitta Dietz |
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Rok vydání: | 2013 |
Předmět: |
Adult
Male Oncology medicine.medical_specialty Time Factors Anti-HIV Agents Cost-Benefit Analysis Human immunodeficiency virus (HIV) Lopinavir/ritonavir HIV Infections medicine.disease_cause Lopinavir immune system diseases Internal medicine medicine Humans Darunavir Pharmacology Sulfonamides Ritonavir business.industry Health Policy Public Health Environmental and Occupational Health virus diseases Health Care Costs Cost-effectiveness analysis Middle Aged Prognosis medicine.disease Resistance mutation United States Drug Combinations Models Economic Treatment Outcome Drug Therapy Combination Female Quality-Adjusted Life Years Lipodystrophy business medicine.drug |
Zdroj: | PharmacoEconomics. 31:427-444 |
ISSN: | 1179-2027 1170-7690 |
Popis: | The ARTEMIS trial compared first-line antiretroviral therapy (ART) with lopinavir/ritonavir (LPV/r) to darunavir plus ritonavir (DRV + RTV) for HIV-1-infected subjects. In order to fully assess the implications of this study, economic modelling extrapolating over a longer term is required.The aim of this study was to simulate the course of HIV and its management, including the multiple factors known to be of importance in ART.A comprehensive discrete event simulation was created to represent, as realistically as possible, ART management and HIV outcomes. The model was focused on patients for whom clinicians believed that LPV/r or DRV + RTV were good options as a first regimen. Prognosis was determined by the impact of initial treatment on baseline CD4+ T-cell count and viral load, adherence, virological suppression/failure/rebound, acquired resistance mutations, and ensuing treatment changes. Inputs were taken from trial data (ARTEMIS), literature and, where necessary, stated assumptions. Clinical measures included AIDS events, side effects, time on sequential therapies, cardiovascular events, and expected life-years lost as a result of HIV infection. The model underwent face, technical and partial predictive validation. Treatment-naive individuals similar to those in the ARTEMIS trial were modelled over a lifetime, and outcomes with first-line DRV + RTV were compared with those with LPV/r, both paired with tenofovir and emtricitabine. Up to three regimen changes were permitted. Drug prices were based on wholesale acquisition cost. Outcomes were lifetime healthcare costs (in 2011 US dollars) from the US healthcare system perspective and quality-adjusted life-years (QALYs) (discounted at 3 % per annum).Choice of LPV/r over DRV + RTV as initial ART resulted in nearly identical clinical outcomes, but distinctly different economic consequences. Starting with an LPV/r regimen potentially results in approximately US$25,000 discounted lifetime savings. Accumulated QALYs for LPV/r and DRV + RTV were 12.130 and 12.083, respectively (a 19-day difference). In sensitivity analyses, net monetary benefit ranged from US$12,000 to US$31,000, favouring LPV/r (base case US$27,762).A comprehensive simulation of lifetime course of HIV in the USA indicated that using LPV/r as first-line therapy compared with DRV + RTV may result in cost savings, with similar clinical outcomes. |
Databáze: | OpenAIRE |
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