Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Experienced (TE) Patients in France

Autor: Anne-Geneviève Marcelin, Laurent Finkielsztejn, Céline Aubin, Audrey Laurisse, Nicolas Despiégel, Hélène Cawston, Caroline Espinas, Gilles Pialoux
Přispěvatelé: Service des maladies infectieuses et tropicales [CHU Tenon], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de virologie [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Optum, Mapi Group, Laboratoire GlaxoSmithKline [ Marly-le-Roi], Viiv Healthcare France, ViiV Healthcare [Brentford, UK]
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Adult
Gerontology
Pyridones
Cost effectiveness
Cost-Benefit Analysis
Population
lcsh:Medicine
Integrase inhibitor
HIV Infections
030312 virology
Piperazines
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Acquired immunodeficiency syndrome (AIDS)
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Drug Resistance
Viral
Oxazines
Humans
Medicine
HIV Integrase Inhibitors
030212 general & internal medicine
lcsh:Science
education
0303 health sciences
education.field_of_study
Multidisciplinary
business.industry
lcsh:R
Cost-effectiveness analysis
medicine.disease
Raltegravir
3. Good health
Quality-adjusted life year
chemistry
Dolutegravir
HIV-1
lcsh:Q
France
Quality-Adjusted Life Years
business
Heterocyclic Compounds
3-Ring
Monte Carlo Method
Research Article
Demography
medicine.drug
Zdroj: PLoS ONE
PLoS ONE, Public Library of Science, 2015, 10 (12), pp.e0145885. ⟨10.1371/journal.pone.0145885.t004⟩
PLoS ONE, Vol 10, Iss 12, p e0145885 (2015)
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0145885.t004⟩
Popis: International audience; ObjectivesTo evaluate the cost-effectiveness of a new generation integrase inhibitor (INI), dolutegravir (DTG), in France, in treatment-experienced (TE) and INI-naïve HIV-infected adults with at least two classes resistance compared to raltegravir (RAL), by adapting previously published Anti-Retroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model.MethodsARAMIS is a microsimulation Markov model with a lifetime time horizon and a monthly cycle length. Health states are defined as with or without opportunistic infection and death. In the initial cohort, efficacy and safety data were derived from a phase III study comparing DTG to RAL. Antiretroviral treatment algorithms, accounting for patient history, were based on French guidelines and experts opinion. Costs are mainly including treatment costs, routine HIV and opportunistic infection care, and death. Utilities depend on CD4+ cell count and the occurrence of opportunistic infections.ResultsThe ARAMIS model indicates in the TE population that DTG compared to RAL over a life time is associated with 0.35 additional quality-adjusted life years (QALY; 10.75 versus 10.41) and additional costs of €7,266 (€390,001 versus €382,735). DTG increased costs are mainly related to a 9.1-month increase in life expectancy for DTG compared with RAL, and consequently a longer time spent on ART. The incremental cost-effectiveness ratio (ICER) for DTG compared with RAL is €21,048 per QALY gained. About 83% and 14% of total lifetime costs are associated with antiretroviral therapy and routine HIV care respectively. Univariate deterministic sensitivity analyses demonstrate the robustness of the model.ConclusionDTG is cost-effective in the management of TE INI naive patients in France, from a collective perspective. These results could be explained by the superior efficacy of DTG in this population and its higher genetic barrier to resistance compared to RAL. These data need to be confirmed with longer-term real life data.
Databáze: OpenAIRE
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