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Mengistu EF, Malik DT, Molla MD, Adugna A, Jemal M. Liver function tests, CD4 + counts, and viral load among people living with HIV on dolutegravir compared to efavirenz-based cART; a comparative cross-sectional study. Heliyon 2024; 10:e33054. [PMID: 38988551 PMCID: PMC11234096 DOI: 10.1016/j.heliyon.2024.e33054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 07/12/2024] Open
Abstract
Background Recently, dolutegravir-based therapy has become the first-line treatment when compared to others. However, dolutegravir-associated side effects in the liver and levels of efficacy haven't been addressed yet in underdeveloped countries such as Ethiopia. Objective The purpose of this study was to compare liver function tests, CD4+ counts, and viral load among people living with HIV on dolutegravir and efavirenz-based antiretroviral regimens at Debre Markos Comprehensive Specialized Hospital in Northwest Ethiopia. Methods An institutional-based comparative cross-sectional study was carried out from May 20 to July 10, 2020. An equal number of dolutegravir and efavirenz-prescribed patients (n = 53 each) for 6 months and above were included, and a judgmental sampling technique was used. A comparison of categorical and continuous parameters was analyzed with chi-square and an independent t-test, respectively, using SPSS version 26. A multivariable logistic regression was conducted and considered statistically significant at a p-value of <0.05. Results The magnitude of liver enzyme (AST/ALT) abnormalities was 22.4 % (12/53) and 30.2 % (16/53) among dolutegravir- and efavirenz-prescribed patients, respectively. The dolutegravir group had significantly higher mean CD4+ counts than the efavirenz group (589.40 ± 244.38 vs. 450.64 ± 203.54 cell/mm3; p = 0.002). The efavirenz group had a significantly higher mean viral load than the dolutegravir group (783.83 ± 476.82 vs. 997.98 ± 439.11 cp/ml; p = 0.032). There was a statistically insignificant difference in AST (p = 0.709) or ALT (p = 0.687) between dolutegravir and efavirenz-based regimens. The multivariable logistic regression analysis revealed that BMI ≥25 kg/m2 was associated with liver enzyme abnormalities (AOR = 6.60, 95 % CI: 1.17, 42.82). Conclusion A dolutegravir-based regimen was more likely to result in patients achieving higher efficacy for viral suppression and a CD4+ count increase. Although the differences were statistically insignificant, the mean AST and ALT levels were marginally higher in efavirenz-treated groups than in dolutegravir-treated groups.
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Affiliation(s)
- Enyew Fenta Mengistu
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Dr Tabarak Malik
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Meseret Derbew Molla
- Department of Biochemistry, School of Medicine, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Adane Adugna
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mohammed Jemal
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Li M, Cao Y, Huang H, Qin G, Chu M, Zou M, Zhuang X. Cost-effectiveness analysis of antiretroviral drugs for treatment-naive HIV infection in China. BMC Public Health 2023; 23:2228. [PMID: 37953277 PMCID: PMC10641994 DOI: 10.1186/s12889-023-17052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION Dolutegravir (DTG)-based regimen was included in the expanded formulary of China's National Free Antiretroviral Treatment Program at the end of 2021. Yet high price of DTG and lack of health economic evaluation in China present barriers for implementation of the regimen. The study aims to investigate the lifetime cost-effectiveness of DTG-based regimen for treatment-naive HIV infection in China. METHODS A decision-analytic Markov model was used to obtain the costs and effectiveness of four regimens: Arm A, efavirenz (EFV)-based regimen; Arm B, DTG-based regimen; Arm C, elvitegravir/cobicistat/tenofovir alafenamide/emtricitabine (EVG/c/FTC/TAF) regimen; Arm D, abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) regimen. The potential impact of national centralized drug procurement policy was assessed in scenario analysis. The results were further validated through sensitivity analysis. RESULTS Compared with other three regimens, DTG-based regimen led to the fewest cumulative adverse reactions, opportunistic infections and deaths. Compared with EFV-based regimen, the base-case ICERs for DTG-based regimen were 13,357 (USD/QALY) and 13,424 (USD/QALY) from the healthcare system and societal perspective respectively. In the policy scenario analysis with the procurement price of DTG equal to that of LPV/r, DTG-based regimen would be dominant. The model results remained robust in sensitivity analyses. CONCLUSIONS DTG-based regimen for treatment-naive patients is likely to be cost-effective and deserve wider implementation in China. This study strongly suggests the centralized procurement of DTG to minimize cost and maximize cost-effectiveness.
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Affiliation(s)
- Min Li
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Chongchuan District, No.9 Seyuan Road, Nantong, Jiangsu, China
- Zhangjiagang Center for Disease Control and Prevention, Department of Infectious Disease Prevention, No.18 Zhizhong Road, Zhangjiagang, Suzhou, Jiangsu, China
| | - Yuxin Cao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Chongchuan District, No.9 Seyuan Road, Nantong, Jiangsu, China
| | - Hao Huang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Chongchuan District, No.9 Seyuan Road, Nantong, Jiangsu, China
| | - Gang Qin
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Chongchuan District, No.9 Seyuan Road, Nantong, Jiangsu, China
| | - Minjie Chu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Chongchuan District, No.9 Seyuan Road, Nantong, Jiangsu, China
| | - Meiyin Zou
- Nantong No.3 hospital affiliated to Nantong University, No.99 Qingnian Zhong Road, Chongchuan District, Nantong, Jiangsu, China
| | - Xun Zhuang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Chongchuan District, No.9 Seyuan Road, Nantong, Jiangsu, China.
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Isah A, Chukwu PO, Abba A, Igboeli NU, Ebere A, Omotola OF, Alozie FA, Ekwunife OI, Adibe MO. Cost-effectiveness of dolutegravir vs. efavirenz-based combined antiretroviral therapies in HIV-infected treatment-naive patients in a Nigerian treatment centre. Afr Health Sci 2023; 23:157-169. [PMID: 37545946 PMCID: PMC10398478 DOI: 10.4314/ahs.v23i1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Dolutegravir (DTG) based antiretroviral therapy (ART) has largely replaced Efavirenz (EFV) based therapy as the preferred first-line regimen in the treatment of adults with HIV. This study was carried out to evaluate the comparative cost-effectiveness of DTG and EFV-based ART in HIV-infected treatment-naïve patients in a treatment centre in Nigeria. METHODS This was a retrospective case-control study of patients initiated on DTG vs. EFV-based regimens from January 2018 to December 2019 at the APIN/HAVARD clinic of Nigeria's Jos University Teaching Hospital. The current viral load result was used to determine treatment effectiveness using a benchmark of ≤200 copies/mL. Sensitivity analysis was carried out to ensure the robustness of the benchmark. The total cost of treatment was obtained by summing up the relevant cost components. Appropriate descriptive and inferential statistics were employed in data analysis using Statistical Product and Services Solutions (SPSS) V.25. The incremental cost-effectiveness ratio of DTG compared to EFV was presented as cost/effectiveness. RESULTS Treatment was effective in 42(51.9%) and 58(71.6%) patients initiated on DTG and EFV-based regimen, respectively. The incremental cost-effective ratio (ICER) of patients on DTG compared to those on EFV was $10.5076 per effectiveness, which was less than 1% of the Nigerian 2019 per capita Gross Domestic Product. Sensitivity analysis showed the robustness of the result. CONCLUSION Efavirenz based regimen had higher treatment effectiveness than DTG-based regimen in treatment-naive patients after initiating treatment in a short term. Compared to EFV, DTG-based regimen is cost-effective in the management of treatment naïve HIV patients.
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Affiliation(s)
- Abdulmuminu Isah
- University of Nigeria Nsukka, Department of Clinical Pharmacy and Pharmacy Management
| | - Patrick O Chukwu
- University of Nigeria Nsukka, Department of Clinical Pharmacy and Pharmacy Management
| | - Abubakar Abba
- University of Nigeria Nsukka, Department of Clinical Pharmacy and Pharmacy Management
| | - Nneka U Igboeli
- University of Nigeria Nsukka, Department of Clinical Pharmacy and Pharmacy Management
| | - Ayogu Ebere
- University of Nigeria Nsukka, Department of Clinical Pharmacy and Pharmacy Management
| | - Olusegun F Omotola
- University of Nigeria Teaching Hospital, Department of Pharmaceutical Services
| | | | - Obinna I Ekwunife
- Nnamdi Azikiwe University, Department of Pharmacy and Pharmacy Management
| | - Maxwell O Adibe
- University of Nigeria Nsukka, Department of Clinical Pharmacy and Pharmacy Management
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Belay YB, Ali EE, Chung KY, Gebretekle GB, Sander B. Cost-Utility Analysis of Dolutegravir- Versus Efavirenz-Based Regimens as a First-Line Treatment in Adult HIV/AIDS Patients in Ethiopia. PHARMACOECONOMICS - OPEN 2021; 5:655-664. [PMID: 34133017 PMCID: PMC8611130 DOI: 10.1007/s41669-021-00275-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND In several countries, the dolutegravir (DTG)-based regimen is generally preferred as first-line antiretroviral therapy (ART) over the efavirenz (EFV)-based regimen, but the evidence in low-income countries is limited. OBJECTIVE Our study aimed to evaluate the cost effectiveness of DTG- versus EFV-based first-line human immunodeficiency virus (HIV) treatment in Ethiopia. METHODS We developed a microsimulation model for the progression of HIV/acquired immune deficiency syndrome (AIDS) to examine the cost effectiveness of DTG-based first-line ART compared with an EFV-based regimen from a healthcare payer perspective. We used a lifetime horizon with a 1-month cycle length and a 3% annual discount rate. The primary outcomes were a lifetime cost in US dollars ($), quality-adjusted life-months (QALMs) that converted to QALYs using the formula QALY = QALM/12, and incremental cost-effectiveness ratio (ICER). Deterministic sensitivity analysis was conducted to account for parameter uncertainty. RESULTS Compared with the EFV-based regimen, the DTG-based regimen was associated with an expected lifetime cost of $12,709 (vs. $12,701) and expected QALYs of 15.3 (vs. 14.7 QALYs) per patient, resulting in an ICER value of $13.33 per QALY. From an alternative analysis with a 5-year time horizon, DTG-based ART was found to be dominant, with expected gains of 0.17 QALYs at a lower cost of $1 per patient. The deterministic sensitivity analysis depicted that the maximum increase in ICER value was $72 per QALY, and all ICER values were below the estimated threshold value. CONCLUSIONS The DTG-based first-line regimen appears to be cost effective compared with the EFV-based regimen for the treatment of HIV/AIDS patients in an Ethiopian setting.
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Affiliation(s)
- Yared Belete Belay
- School of Pharmacy, College of Health Sciences, Mekelle University, PO Box 1871, Mekelle, Ethiopia.
| | - Eskinder Eshetu Ali
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Karen Y Chung
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Torono, ON, Canada
| | - Gebremedhin Beedemariam Gebretekle
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Torono, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Torono, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Wittevrongel M, Apers L. The efficiency of the EmERGE pathway to provide continuity of care for medically stable people living with HIV in Belgium. Acta Clin Belg 2021; 77:915-924. [PMID: 34802399 DOI: 10.1080/17843286.2021.2004697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Butler K, Anderson SJ, Hayward O, Jacob I, Punekar YS, Evitt LA, Oglesby A. Cost-effectiveness and budget impact of dolutegravir/lamivudine for treatment of human immunodeficiency virus (HIV-1) infection in the United States. J Manag Care Spec Pharm 2021; 27:891-903. [PMID: 34185564 PMCID: PMC10391195 DOI: 10.18553/jmcp.2021.27.7.891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Dolutegravir(DTG)/lamivudine(3TC) is the first 2-drug regimen recommended as an initial treatment for people living with HIV (PLHIV). OBJECTIVE: To assess the cost-effectiveness and potential budget impact of DTG/3TC in the US healthcare setting. METHODS: A previously published hybrid decision-tree and Markov cohort state transition model was adapted to estimate the incremental costs and health outcome benefits over a patients' lifetime. DTG/3TC was compared with current standard of care in treatment naive and treatment experienced virologically suppressed PLHIV. Health states included in the model were based upon virologic response and CD4 cell count, with death as an absorbing state. Clinical data was informed by the Phase III GEMINI 1 and 2 clinical trials, a published network meta-analysis (NMA) in treatment-naive patients and the Phase III TANGO clinical trial in treatment experienced patients. Costs and utilities were informed by published data and discounted annually at a rate of 3%. A separate 5-year budget impact analysis was conducted assuming 5%-15% uptake in eligible treatment naive and 10%-30% uptake in eligible treatment experienced patients. RESULTS: In the treatment naive analyses based on GEMINI 1 and 2, DTG/3TC dominated, i.e., was less costly and more effective, than all comparators. DTG/3TC resulted in 0.083 incremental quality-adjusted life-years (QALYs) at a cost saving of $199,166 compared with the DTG + tenofovir disoproxil(TDF)/emtricitabine(FTC) comparator arm. The incremental QALY and cost savings for DTG/3TC compared with DTG/abacavir(ABC)/3TC, cobicistat-boosted darunavir(DRV/c)/tenofovir alafenamide(TAF)/FTC, and bictegravir (BIC)/TAF/FTC, based on NMA results were 0.465, 0.142, and 0.698, and $42,948, $122,846, and $44,962, respectively. In the analyses of treatment-experienced virologically suppressed patients based on TANGO, DTG/3TC offered slightly lower QALYs (-0.037) with an estimated savings of $78,730 when compared with continuation of TAF-based regimen (TBR). Sensitivity analyses demonstrated that these conclusions were relatively insensitive to alternative parameter estimates. The budget impact analysis estimated that by 5th year a total of 70,240 treatment naive patients and 1,340,480 treatment experienced patients could be eligible to be prescribed DTG/3TC. The estimated budget savings over 5 years ranged from $1.12b to $3.35b (corresponding to 27,512 to 82,536 on DTG/3TC by year 5) in the lowest and highest uptake scenarios, respectively. CONCLUSION: In conclusion, DTG/3TC with its comparable efficacy and lower drug acquisition costs, has the potential to offer significant cost savings to US healthcare payers for the initial treatment of treatment naive patients and as a treatment switching option for virologically suppressed patients. DISCLOSURES: This study was funded in full by ViiV healthcare, Brentford, UK. Medical writing to support this study was also funded in full by ViiV Healthcare, Brentford, UK. Butler, Hayward, and Jacob are employees of HEOR Ltd, the company performing this study funded by ViiV Healthcare. Anderson is an employee of GlaxoSmithKline and owns shares in the company. Punekar, Evitt, and Oglesby are employees of ViiV Healthcare and own stocks in GlaxoSmithKline.
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Affiliation(s)
- Karin Butler
- Health Economics & Outcomes Research Ltd, Cardiff, United Kingdom
| | | | - Olivia Hayward
- Health Economics & Outcomes Research Ltd, Cardiff, United Kingdom
| | - Ian Jacob
- Health Economics & Outcomes Research Ltd, Cardiff, United Kingdom
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Parker B, Ward T, Hayward O, Jacob I, Arthurs E, Becker D, Anderson SJ, Chounta V, Van de Velde N. Cost-effectiveness of the long-acting regimen cabotegravir plus rilpivirine for the treatment of HIV-1 and its potential impact on adherence and viral transmission: A modelling study. PLoS One 2021; 16:e0245955. [PMID: 33529201 PMCID: PMC7853524 DOI: 10.1371/journal.pone.0245955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Combination antiretroviral therapy (cART) improves outcomes for people living with HIV (PLWH) but requires adherence to daily dosing. Suboptimal adherence results in reduced treatment effectiveness, increased costs, and greater risk of resistance and onwards transmission. Treatment with long-acting (LA), injection-based ART administered by healthcare professionals (directly observed therapy (DOT)) eliminates the need for adherence to daily dosing and may improve clinical outcomes. This study reports the cost-effectiveness of the cabotegravir plus rilpivirine LA regimen (CAB+RPV LA) and models the potential impact of LA DOT therapies. Methods Parameterisation was performed using pooled data from recent CAB+RPV LA Phase III trials. The analysis was conducted using a cohort-level hybrid decision-tree and state-transition model, with states defined by viral load and CD4 cell count. The efficacy of oral cART was adjusted to reflect adherence to daily regimens from published data. A Canadian health service perspective was adopted. Results CAB+RPV LA is predicted to be the dominant intervention when compared to oral cART, generating, per 1,000 patients treated, lifetime cost-savings of $1.5 million, QALY and life-year gains of 107 and 138 respectively with three new HIV cases averted. Conclusions Economic evaluations of LA DOTs need to account for the impact of adherence and HIV transmission. This study adds to the existing literature by incorporating transmission and using clinical data from the first LA DOT regimen. Providing PLWH and healthcare providers with novel modes of ART administration, enhancing individualisation of treatment, may facilitate the achievement of UNAIDS 95-95-95 objectives.
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Affiliation(s)
- Ben Parker
- Health Economics and Outcomes Research Ltd, Pontprennau, Cardiff, United Kingdom
| | - Tom Ward
- Health Economics and Outcomes Research Ltd, Pontprennau, Cardiff, United Kingdom
| | - Olivia Hayward
- Health Economics and Outcomes Research Ltd, Pontprennau, Cardiff, United Kingdom
| | - Ian Jacob
- Health Economics and Outcomes Research Ltd, Pontprennau, Cardiff, United Kingdom
- * E-mail: (IJ); (NVdV)
| | - Erin Arthurs
- Health Economics & Outcomes Research, GlaxoSmithKline, Toronto, Ontario, Canada
| | - Debbie Becker
- Quadrant Health Economics Inc, Cambridge, Ontario, Canada
| | - Sarah-Jane Anderson
- Value Evidence and Outcomes, GlaxoSmithKline, Brentford, Middlesex, United Kingdom
| | - Vasiliki Chounta
- Global Health Outcomes, ViiV Healthcare Ltd, Brentford, Middlesex, United Kingdom
| | - Nicolas Van de Velde
- Global Health Outcomes, ViiV Healthcare Ltd, Brentford, Middlesex, United Kingdom
- * E-mail: (IJ); (NVdV)
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Belay YB, Ali EE, Sander B, Gebretekle GB. Health-related quality of life of patients with HIV/AIDS at a tertiary care teaching hospital in Ethiopia. Health Qual Life Outcomes 2021; 19:24. [PMID: 33468153 PMCID: PMC7816449 DOI: 10.1186/s12955-021-01670-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 01/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients’ health-related quality of life (HRQoL) and health state utility values are critical inputs in the clinical and economic evaluation of treatments for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). However, information on health state utility values is lacking in the context of Ethiopia. Here, we aimed to assess HRQoL and determine health state utility values and factors that influence the values among HIV/AIDS patients in Ethiopia.
Methods A cross-sectional study was conducted among 511 HIV/AIDS patients at Tikur Anbessa Specialized Hospital in Ethiopia. Patients aged 18 years or older were eligible for the interview and those who were mentally unstable and with hearing impairment were excluded from the study. We performed face-to-face interviews using EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) in combination with EuroQol-Visual Analog Scales (EQ-VAS). Level-specific disutility coefficients obtained from the general population were used for computing utility values. Patients’ health profiles were described using percentages and different statistical analysis were conducted to determine factors associated with the EQ-5D index and EQ-VAS scores.
Results A total of 511 patients participated in the study. A higher proportion of patients reported slight or more severe problems on the anxiety/depression (55.2%) and pain/discomfort (51.3%) dimensions. The overall median utility value of HIV/AIDS patients was 0.94 (IQR = 0.87, 1) from the EQ-5D index and 80% (IQR = 70%, 90%) from the EQ-VAS scores. Demographic characteristics including age, occupational status, and household monthly income significantly affected patient’s utility values. Moreover, statistically significant (p < 0.001) differences were seen between the EQ-5D index values of patients with different CD4 count intervals. Furthermore, number of medicines that the patients were taking at the time of the study and comorbidities were significantly associated with the EQ-5D utility index and EQ-VAS score, p < 0.001. Conclusions The anxiety/depression and pain/ discomfort dimensions were identified to have critical influence in reducing the HRQoL of adult HIV/AIDS patients in the context of Ethiopia. The study is also the first to use the EQ-5D-5L tool to identify health state utility values for Ethiopian adult HIV/AIDS patients. Future economic evaluations of HIV/AIDS interventions are encouraged to employ the identified utility values.
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Affiliation(s)
- Yared Belete Belay
- School of Pharmacy, College of Health Sciences, Mekelle University, Mek'ele, Ethiopia.
| | - Eskinder Eshetu Ali
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Gebremedhin Beedemariam Gebretekle
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
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Davis W, Mantsios A, Karver T, Murray M, Punekar Y, Ward D, Bredeek UF, Moreno S, Merino D, Knobel H, Campis A, Kerrigan D. "It made me more confident that I have it under control": Patient and provider perspectives on moving to a two-drug ART regimen in the United States and Spain. PLoS One 2020; 15:e0232473. [PMID: 32357195 PMCID: PMC7194407 DOI: 10.1371/journal.pone.0232473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Two-drug regimens (2DR) to treat HIV infection have the potential to reduce long-term toxicity and increase therapeutic options for people living with HIV (PLHIV). Prior phase III trials, SWORD-1 and SWORD-2, as well as GEMINI-1 and GEMINI-2, have demonstrated that a dolutegravir-based 2DR is as effective as three- or four-drug regimens among virologically suppressed patients. Limited information exists, however, on patient and provider experiences with 2DR to inform roll-out and integration into routine clinical care. METHODS We conducted 39 in-depth interviews with PLHIV currently on 2DR in the context of routine care and 8 of their clinical care providers in the United States (U.S.) and Spain. Participants included 33 male and 6 female PLHIV and 8 providers. Interview topics explored perceptions of and experiences with 2DR compared to prior anti-retroviral regimens (ARVs), side effects, patient satisfaction, and clinical performance. Interviews were audio-recorded, transcribed and analyzed using thematic content analysis. RESULTS Participants viewed 2DR as a significant and positive advance, in terms of its ability to effectively treat HIV with reduced toxicity and essentially no reported side effects. Patients noted the central role providers played in the decision to switch to a 2DR regimen and, among U.S. participants, the importance of insurance coverage making this preferred option feasible. Patients and providers agreed that a 2DR regimen would be appropriate for any PLHIV regardless of whether they were treatment naïve or had significant experience with ARVs. CONCLUSIONS Participants' experiences with a 2DR regimen were positive with no participants, reporting side effects and all reporting continued viral suppression. Providers valued the reduced toxicity offered by 2DR and served as the primary gateway to a transition to 2DR for patients in both settings. This study provides a foundation for further research on the transition to 2DR regimens in other populations and contexts including low- and middle-income settings.
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Affiliation(s)
- Wendy Davis
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
- * E-mail:
| | - Andrea Mantsios
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Tahilin Karver
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Miranda Murray
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Yogesh Punekar
- ViiV Healthcare, Raleigh, North Carolina, United States of America
| | - Douglas Ward
- Dupont Circle Physicians Group, Washington, D.C., United States of America
| | - U. Fritz Bredeek
- Metropolis Medical Group, San Francisco, California, United States of America
| | | | | | | | | | - Deanna Kerrigan
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
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Punekar YS, Guo N, Tremblay G, Piercy J, Holbrook T, Young B. Improving access to antiretrovirals in China: economic analyses of dolutegravir in HIV-1 patients. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:26. [PMID: 31827410 PMCID: PMC6896323 DOI: 10.1186/s12962-019-0195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/26/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The World Health Organisation recommended dolutegravir (DTG)-based antiretroviral therapy (ART) regimens are available but not reimbursed through the public reimbursement system in China. The objective of this analysis was to evaluate the cost-effectiveness of DTG (DTG + TDF/3TC) compared to efavirenz (EFV + TDF/3TC) in treatment-naive and ritonavir-boosted lopinavir (LPV/r + TDF/3TC) in first-line ART failure HIV-1-infected patients in China. METHODS A dynamic Markov model comprising of 5 response states and 6 CD4+ count-based health states was used. Efficacy, estimated as probability of virologic suppression (HIV RNA < 50 copies/mL) at 48 weeks, was obtained from a published network meta-analysis for ART-naive patients and from the DAWNING study for patients failing first-line ART. Baseline cohort characteristics were informed using DTG phase 3 studies and the DAWNING study data, respectively. Health state utilities were derived from DTG phase 3 studies. A 5-year cost-effectiveness analyses was conducted using the societal perspective. Outcomes were quality-adjusted-life-years (QALYs), life-years (LYs), incremental cost per QALYs (ICER). RESULTS The viral suppression rates for DTG + TDF/3TC were higher than EFV + TDF/3TC (75.3% vs 64.0%) in treatment-naive and LPV/r + TDF/3TC (74.8% vs 58.4%) in first-line ART failure patients. This resulted in higher QALYs for DTG + TDF/3TC in treatment-naive (4.232 vs 4.227) and first-line failure settings (4.224 vs 4.221). Total discounted cost for DTG + TDF/3TC patients (RMB 219.259 in treatment-naive and RMB 238,746 in first-line failures) were lower than comparators (EFV + TDF/3TC:RMB 221,605; LPV/r + TDF/3TC:RMB 244,364), thereby DTG dominated in both settings. Probabilistic sensitivity analyses indicated the probability of DTG + TDF/3TC being cost effective was 98.2% in treatment-naive setting and 100% in first-line failure setting at a willingness to pay threshold of RMB 100,000/QALY. CONCLUSIONS With lower costs, higher response rates and higher QALYs, DTG + TDF/3TC can be considered as a cost-effective alternative for treatment naive and first-line failure patients in China.
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Affiliation(s)
| | - Na Guo
- GlaxoSmithKline, Shanghai, China
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Tremblay G, Chounta V, Piercy J, Holbrook T, Garib SA, Bukin EK, Punekar YS. Cost-Effectiveness of Dolutegravir as a First-Line Treatment Option in the HIV-1-Infected Treatment-Naive Patients in Russia. Value Health Reg Issues 2018; 16:74-80. [PMID: 30296624 DOI: 10.1016/j.vhri.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/28/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate the cost effectiveness of dolutegravir + abacavir/lamivudine (DTG + ABC/3TC) compared with raltegravir + abacavir/lamivudine (RAL + ABC/3TC) and ritonavir-boosted darunavir + abacavir/lamivudine (DRV/r + ABC/3TC) in HIV-1-infected treatment-naive patients in Russia. METHODS A dynamic Markov model was developed with five response states and six CD4+-based health states. Efficacy estimated as probability of viral suppression (HIV RNA <50 copies/ml) at 48 weeks was obtained from a published network meta-analysis. Baseline cohort characteristics and health state utilities were informed using DTG phase 3 clinical trials. Health care resource use was obtained from literature and costed using published unit costs. Costs (presented in Russian rubles) included antiretroviral drug costs; HIV management costs such as routine care; costs of treating cardiovascular conditions, opportunistic infections, and drug-related adverse effects; and mortality costs. A patient lifetime analysis was conducted using the societal perspective. Outcomes were quality-adjusted life-years (QALYs), life-years, incremental cost per QALY ratio, and incremental cost per responder. RESULTS The viral suppression rate among patients receiving DTG + ABC/3TC was 71.7% compared with 65.2% for RAL + ABC/3TC and 59.6% for DRV/r + ABC/3TC. The mean duration of response per patient was 116.6 months for DTG + ABC/3TC, 108.6 months for RAL + ABC/3TC, and 98.9 months for DRV/r + ABC/3TC. Total discounted costs for treatment over patient lifetime were RUB 2.89, 5.32, and 4.38 million for DTG + ABC/3TC, RAL + ABC/3TC, and DRV/r + ABC/3TC, respectively. Lifetime discounted QALYs were 12.73 for patients on DTG + ABC/3TC and 12.72 each for patients on RAL + ABC/3TC and DRV/r + ABC/3TC. DTG + ABC/3TC thus dominated the other two alternatives. CONCLUSIONS With lower costs, higher response rates, and comparable QALYs, DTG + ABC/3TC can be considered as a cost-effective alternative.
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Sim J, Hill A. Is pricing of dolutegravir equitable? A comparative analysis of price and country income level in 52 countries. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30311-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sim J, Hill A. Is pricing of dolutegravir equitable? A comparative analysis of price and country income level in 52 countries. J Virus Erad 2018; 4:230-237. [PMID: 30515303 PMCID: PMC6248837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Differences in marketed prices of antiretrovirals raises questions about the fairness of pricing medicines of significant public health importance such as dolutegravir (DTG). In view of the reduced prices of generically available efavirenz (EFV), there is a need to determine if previous conclusions on DTG's cost-effectiveness need to be re-assessed. METHODS Lowest list prices of DTG were extracted from national drug price or reimbursement databases for 52 countries. Price was recorded as US$ per person-year (ppy). We compared the price of DTG to minimum costs of production and reduced prices of EFV, as well as assessed the correlation with gross domestic product (GDP) per capita and HIV epidemic size in three income classification groups ('high', 'upper middle-income', 'lower middle or low-income'). RESULTS Annual prices of DTG ranged from $27 per person-year in Georgia to $20,130 in the USA. Within each income group, there was no observable relationship between DTG prices, GDP per capita and HIV epidemic size. Median price in countries excluded from voluntary licensing agreements ($8718) was >140 times higher than countries included ($60). Price of DTG was >500% higher than EFV in many countries. Three full economic evaluations from high-income settings that compared DTG against EFV all used branded drug prices of EFV-based regimens as cost inputs to evaluate DTG's cost-effectiveness. CONCLUSIONS This study highlights the wide disparity in prices of DTG across countries, even when segregated by similar income levels. The cost-effectiveness of DTG versus EFV should be re-evaluated now that low-cost generic EFV has become widely available.
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Affiliation(s)
- Joel Sim
- Faculty of Medicine, Imperial College London,
London,
UK
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool,
UK
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Daimari R, Kwape L, Oyekunle AA. Suicidal overdose of dolutegravir: A case report. South Afr J HIV Med 2018. [DOI: 10.4102/sajhivmed.v19i1.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Dolutegravir (DTG) is the most recently introduced integrase inhibitor for the treatment of HIV infection and is preferred for its superior tolerability and efficacy in both new and pre-treated patients, and infrequent drug interactions. Since January 2017, Botswana has adopted a ‘treat-all’ approach with a DTG-based antiretroviral (ARV) regimen as first-line treatment. We report a 29-year-old man with clinical stage 1 HIV infection who had been started on DTG, tenofovir and emtricitabine eight months prior, and who was admitted following a suicidal overdose of 1500 mg of DTG. He reported only minor symptoms including vomiting, epigastric pain and dizziness; which promptly resolved following supportive treatment. On admission, full blood count, liver function tests and electrocardiography were unremarkable. However, there was a non-progressive increase in serum creatinine. After a month off ARVs, he was successfully restarted on antiretroviral therapy without any serious adverse effect.
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Mendes JC, Bonolo PDF, Ceccato MDGB, Costa JDO, Reis AMM, Dos Santos H, Silveira MR. Adverse reactions associated with first-line regimens in patient initiating antiretroviral therapy. Eur J Clin Pharmacol 2018; 74:1077-1088. [PMID: 29740676 DOI: 10.1007/s00228-018-2472-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/25/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the prevalence of adverse drug reactions (ADR) and associated factors during the use of Highly Active Antiretroviral Therapy (HAART) in patients initiating treatment. METHODS This is a cross-sectional analysis of a prospective study conducted in three public referral services specialized in HIV/AIDS care in Belo Horizonte, Brazil. Self-reported ADR and explanatory variables were obtained from face-to-face interview and from Information Systems. Associated factors with ADR were evaluated by logistic regression in SPSS software v.22. RESULTS We included 399 patients, of which 85.5% reported at least one and 72.7% up to 5 ADRs after HAART initiation. Neurological reactions were the most frequent, with self-reported ADRs being distinct according to HAART regimen used. The global model showed higher chance of ADRs among females (OR = 3.52) and illicit drug users (OR = 2.28). Lower chance of ADRs was found for patients aged > 33 years (OR = 0.37), DTG/TDF/3TC users (OR = 0.41), and higher physical domain of quality of life (OR = 0.78). The model restricted to patients using the single-tablet regimen EFV/TDF/3TC showed lower ADRs among patients with CD4+ T lymphocyte count > 200 cells/mm3 (OR = 0.23) and higher independence domain of quality of life (OR = 0.74). The model restricted to DTG/TDF/3TC and to other regimens showed lower ADRs with higher physical domain of quality of life (OR = 0.74 and OR = 0.55, respectively). CONCLUSIONS The prevalence of self-reported ADRs to first-line antiretroviral regimens was high and patients using DTG/TDF/3TC had a smaller number of ADRs. In addition to HAART regimen, sociodemographic, clinical, and quality of life characteristics were associated with ADRs.
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Affiliation(s)
- Jullye Campos Mendes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Palmira de Fátima Bonolo
- Faculdade de Medicina, Universidade Federal de Minas Gerais-UFMG, Avenida Professor Alfredo Balena 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Juliana de Oliveira Costa
- Faculdade de Medicina, Universidade Federal de Minas Gerais-UFMG, Avenida Professor Alfredo Balena 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Henrique Dos Santos
- Instituto de Educação Continuada, Pontifícia Universidade Católica de Minas Gerais-PUC Minas, Rua Cláudio Manoel 1205, Funcionários, Belo Horizonte, Minas Gerais, 30140-100, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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Zheng A, Kumarasamy N, Huang M, Paltiel AD, Mayer KH, Rewari BB, Walensky RP, Freedberg KA. The cost-effectiveness and budgetary impact of a dolutegravir-based regimen as first-line treatment of HIV infection in India. J Int AIDS Soc 2018; 21:e25085. [PMID: 29603882 PMCID: PMC5878415 DOI: 10.1002/jia2.25085] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 02/01/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Dolutegravir (DTG)-based antiretroviral therapy (ART) is recommended for first-line HIV treatment in the US and Europe. Efavirenz (EFV)-based regimens remain the standard of care (SOC) in India. We examined the clinical and economic impact of DTG-based first-line ART in the setting of India's recent guidelines change to treating all patients with HIV infection regardless of CD4 count. METHODS We used a microsimulation of HIV disease, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-International model, to project outcomes in ART-naive patients under two strategies: (1) SOC: EFV/tenofovir disoproxil fumarate (TDF)/lamivudine (3TC); and (2) DTG: DTG + TDF/3TC. Regimen-specific inputs, including virologic suppression at 48 weeks (SOC: 82% vs. DTG: 90%) and annual costs ($98 vs. $102), were informed by clinical trial data and other sources and varied widely in sensitivity analysis. We compared incremental cost-effectiveness ratios (ICERs), measured in $/year of life saved (YLS), to India's per capita gross domestic product ($1600 in 2015). We compared the budget impact and HIV transmission effects of the two strategies for the estimated 444,000 and 916,000 patients likely to initiate ART in India over the next 2 and 5 years. RESULTS Compared to SOC, DTG improved 5-year survival from 76.7% to 83.0%, increased life expectancy from 22.0 to 24.8 years (14.0 to 15.5 years, discounted), averted 13,000 transmitted HIV infections over 5 years, increased discounted lifetime care costs from $3040 to $3240, and resulted in a lifetime ICER of $130/YLS, less than 10% of India's per capita GDP in 2015. DTG maintained an ICER below 50% of India's per capita GDP as long as the annual three-drug regimen cost was ≤$180/year. Over a 2- or 5-year horizon, total undiscounted outlays for HIV-related care were virtually the same for both strategies. CONCLUSIONS A generic DTG-based regimen is likely to be cost-effective and should be recommended for initial therapy of HIV infection in India.
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Affiliation(s)
- Amy Zheng
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
| | | | - Mingshu Huang
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
| | | | - Kenneth H Mayer
- Harvard Medical SchoolBostonMAUSA
- The Fenway InstituteFenway HealthBostonMAUSA
- Beth Israel Deaconess Medical CenterBostonMAUSA
| | - Bharat B Rewari
- HIV/STI/Hepatitis Unit, Department of Communicable Diseases, World Health Organization Regional Office for South‐East AsiaNew DelhiIndia
| | - Rochelle P Walensky
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Division of General Internal MedicineMassachusetts General HospitalBostonMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMAUSA
- Division of Infectious DiseasesBrigham and Women's HospitalBostonMAUSA
| | - Kenneth A Freedberg
- Medical Practice Evaluation CenterMassachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
- Division of General Internal MedicineMassachusetts General HospitalBostonMAUSA
- Division of Infectious DiseasesMassachusetts General HospitalBostonMAUSA
- Department of Health Policy and ManagementHarvard T.H.Chan School of Public HealthBostonMAUSA
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Pialoux G, Marcelin AG, Cawston H, Guilmet C, Finkielsztejn L, Laurisse A, Aubin C. Cost-effectiveness of dolutegravir/abacavir/lamivudine in HIV-1 treatment-Naive (TN) patients in France. Expert Rev Pharmacoecon Outcomes Res 2017; 18:83-91. [PMID: 28741965 DOI: 10.1080/14737167.2017.1359542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND To evaluate the cost-effectiveness of an integrase inhibitor (INI), dolutegravir (DTG), in combination with abacavir (ABC)/lamivudine (3TC) in France, in treatment-naive (TN) HIV adult patients. METHODS The ARAMIS microsimulation Markov model, evaluates costs and effects of DTG vs. first-line ARVs options including INIs (raltegravir, elvitegravir/c), protease inhibitors (PIs) (darunavir/r, atazanavir/r, lopinavir/r), non-nucleoside reverse transcriptase inhibitors (efavirenz and rilpivirine). Efficacy and safety data were derived from phase III studies and network meta-analysis. Treatment algorithms were based on French guidelines and experts opinion. Costs included routine HIV and opportunistic infection care, and death. RESULTS The model showed the fixed-dose combination DTG/ABC/3TC was more effective than all other recommended regimens: patients stayed longer on first-line, and lived longer and healthier. With the exception of EFV, DTG/ABC/3TC was more efficacious and less costly compared to all strategies. The cost per QALY gained (ICER) for DTG compared to EFV was €6,939. DTG/ABC/3TC was more efficacious and less costly compared to INIs and PIs in all deterministic sensitivity analyses. CONCLUSION DTG/ABC/3TC was cost-effective in the management of HIV TN patients in France. These results are mainly explained by its lower price compared to other INIs and PIs, DTG's superior efficacy and high barrier to resistance.
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Affiliation(s)
- Gilles Pialoux
- a Service des Maladies Infectieuses et Tropicales , AP-HP Hôpital Tenon , PARIS , France
| | - Anne-Geneviève Marcelin
- b Service de Virologie, Inserm UMR_S 1136 , UPMC Univ Paris 06, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles FoixParis , Paris , France
| | - Hélène Cawston
- c Real World Strategy & Analytics, Mapi Group , Nanterre , France
| | - Caroline Guilmet
- c Real World Strategy & Analytics, Mapi Group , Nanterre , France
| | | | - Audrey Laurisse
- e EU Payer Solution & Access Manager, Viiv Healthcare , Rueil-Malmaison , France
| | - Céline Aubin
- f Health Economics and Outcomes Research, Viiv Healthcare , Rueil-Malmaison , France
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Restelli U, Rizzardini G, Antinori A, Lazzarin A, Bonfanti M, Bonfanti P, Croce D. Cost-effectiveness analysis of dolutegravir plus backbone compared with raltegravir plus backbone, darunavir+ritonavir plus backbone and efavirenz/tenofovir/emtricitabine in treatment naïve and experienced HIV-positive patients. Ther Clin Risk Manag 2017; 13:787-797. [PMID: 28721059 PMCID: PMC5499774 DOI: 10.2147/tcrm.s135972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background In January 2014, the European Medicines Agency issued a marketing authorization for dolutegravir (DTG), a second-generation integrase strand transfer inhibitor for HIV treatment. The study aimed at determining the incremental cost-effectiveness ratio (ICER) of the use of DTG+backbone compared with raltegravir (RAL)+backbone, darunavir (DRV)+ritonavir(r)+backbone and efavirenz/tenofovir/emtricitabine (EFV/TDF/FTC) in HIV-positive treatment-naïve patients and compared with RAL+backbone in treatment-experienced patients, from the Italian National Health Service’s point of view. Materials and methods A published Monte Carlo Individual Simulation Model (ARAMIS-DTG model) was used to perform the analysis. Patients pass through mutually exclusive health states (defined in terms of diagnosis of HIV with or without opportunistic infections [OIs] and cardiovascular disease [CVD]) and successive lines of therapy. The model considers costs (2014) and quality of life per monthly cycle in a lifetime horizon. Costs and quality-adjusted life years (QALYs) are dependent on OI, CVD, AIDS events, adverse events and antiretroviral therapies. Results In treatment-naïve patients, DTG dominates RAL; compared with DRV/r, the ICER obtained is of 38,586 €/QALY (6,170 €/QALY in patients with high viral load) and over EFV/TDF/FTC, DTG generates an ICER of 33,664 €/QALY. In treatment-experienced patients, DTG compared to RAL leads to an ICER of 12,074 €/QALY. Conclusion The use of DTG+backbone may be cost effective in treatment-naïve and treatment-experienced patients compared with RAL+backbone and in treatment-naïve patients compared with DRV/r+backbone and EFV/TDF/FTC considering a threshold of 40,000 €/QALY.
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Affiliation(s)
- Umberto Restelli
- Centre for Research on Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Varese, Italy.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Giuliano Rizzardini
- First and Second Divisions of Infectious Diseases, "Luigi Sacco" Hospital, Milan, Italy.,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea Antinori
- National Institute for Infectious Diseases "L Spallanzani", Rome
| | - Adriano Lazzarin
- Department of Infectious Diseases, San Raffaele Scientific Institute
| | - Marzia Bonfanti
- Centre for Research on Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Varese, Italy
| | - Paolo Bonfanti
- Department of Infectious and Tropical Diseases, A Manzoni Hospital, Lecco, Italy
| | - Davide Croce
- Centre for Research on Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Varese, Italy.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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