Cost-effectiveness of lopinavir/ritonavir versus nelfinavir as the first-line highly active antiretroviral therapy regimen for HIV infection

PURPOSE

Selecting the optimal treatment regimen for antiviral-naive patients may be difficult, given the concern about the antiviral activity, the development of drug resistance, and the increase in drug costs. This study evaluates the costs and effectiveness of using lopinavir/ritonavir (LPV/r) vs. nelfinavir (NFV), both coadministered with stavudine and lamivudine, as the first HAART regimen in treating HIV patients, based on the results from the published clinical trial M98-863.

METHOD

A Markov model was developed using a combination of viral load (VL) and CD4 count as surrogate markers to define health states. VL and CD4 count data from the 48-week analysis of the clinical trial were used as measures of effect. The impact of resistance difference between NFV and LPV/r was also examined.

RESULTS

Over the first 5 years, the model estimated that LPV/r could save $3,461 USD per patient in total HIV care costs compared with NFV. If the resistance advantage of LPV/r was taken into account, the cost savings by LPV/r increased to $5,546 USD. For longer term projection, without considering the resistance difference, the incremental cost-effectiveness ratio (CER) for LPV/r vs. NFV was $6,653 USD per quality-adjusted life-year (QALY). This CER compares favorably to therapies for HIV disease and for common drug treatments for other conditions and is well within accepted thresholds for health policy makers.

CONCLUSION

When treatment options are being considered, this study suggests that use of LPV/r in the first antiretroviral regimen, as compared to NFV, is cost-effective based on improved efficacy and resistance.

Backlash over ritonavir price hike

On December 3, 2003, Abbott Laboratories, the pharmaceutical company that makes lopinavir (Kaletra), announced that it was going to raise the price of its other anti-HIV drug, ritonavir (Norvir), from $2.14 to $10.72 per capsule in the U.S.--an increase of 400%. (These prices reflect the Average Wholesale Price, or AWP, a national average of list prices charged by wholesalers to pharmacies.)

Abbott Laboratories increases Norvir price fivefold

On December 4, Abbott Laboratories increased the price of tis drug Norvir fivefold--possibly the largest out-of-the-blue overnight price increase for a life-critical medicine in history.

Recent developments in antiretroviral therapy

This article reviews the antiretroviral medications in development as presented at the Eighth Annual Conference on Retroviruses and Opportunistic Infections. New medications for the treatment of HIV/AIDS are discussed by classification and a brief description of its unique quality is described.