1
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Mpoudi-Etame M, Tovar Sanchez T, Bousmah MAQ, Omgba Bassega P, Olinga J, Mimbe E, Foalem M, Chiep C, Edimo S, Varloteaux M, Pelloquin R, Lamare N, Boyer S, Peeters M, Reynes J, Calmy A, Hill A, Delaporte E, Kouanfack C. Durability of the Efficacy and Safety of Dolutegravir-Based and Low-Dose Efavirenz-Based Regimens for the Initial Treatment of Human Immunodeficiency Virus Type 1 Infection in Cameroon: Week 192 Data of the NAMSAL-ANRS-12313 Study. Open Forum Infect Dis 2023; 10:ofad582. [PMID: 38156046 PMCID: PMC10754645 DOI: 10.1093/ofid/ofad582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
Background A prospective study was extended to the new antiretroviral and monitoring strategies in HIV-infected adults in low-income countries (NAMSAL-ANRS)-12313 trial, a 96-week open-label, multicenter, randomized phase 3 trial comparing dolutegravir (DTG) 50 mg with efavirenz 400 mg (EFV400), both administered with tenofovir disoproxil fumarate and lamivudine (TDF/3TC) as first-line treatment for antiretroviral therapy (ART)-naive people living with human immunodeficiency virus type 1 (HIV). Noninferiority of DTG to EFV400 was demonstrated at 48-week and sustained at 96 weeks. Here, we present results at 192-week. Methods Previous trial participants were reconsented and followed up on their initial randomization arm (1:1 DTG/TDF/3TC:EFV400/TDF/3TC). Assessments included changes in viral suppression, biological parameters, and new serious adverse events (SAEs). Results Among the participants enrolled in the trial, 81% (499/613) were analyzed at week 192: 84% (261/310) on DTG/TDF/3TC and 78% (238/303) on EFV400/TDF/3TC. HIV RNA suppression was maintained in 69% (214/310) on DTG/TDF/3TC-based and 62% (187/303) on EFV400/TDF/3TC-based regimens (difference, 7.3% [95% confidence interval, -.20 to 14.83]; P = .057). Five (DTG/TDF/3TC = 2; EFV400/TDF/3TC = 3) new viral failures (World Health Organization definition) without related resistance DTG mutations and 24 new SAEs were observed (DTG/TDF/3TC = 13; EFV400/TDF/3TC = 11). Mean weight gain was +9.4 kg on DTG/TDF/3TC and +5.9 kg on EFV400/TDF/3TC. The percentage of participants with obesity increased from 6.9% to 27.7% on DTG/TDF/3TC (P < .0001) and from 8.3% to 16.7% on EFV400/TDF/3TC (P = .0033). Conclusions Four-year follow-up of people with HIV on DTG- and EFV400-based regimens showed long-term efficacy and safety of both ARTs, markedly among participants on DTG/TDF/3TC with high baseline viral load. However, unexpected substantial weight gain over time was prominent among participants on DTG/TDF/3TC, which should be closely monitored. Clinical Trials Registration. NCT02777229.
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Affiliation(s)
- Mireille Mpoudi-Etame
- Service Spécialisé d'Epidemiologie et Maladies Infectieuses, Hopital Militaire de Région No.1 Yaoundé, Yaoundé, Cameroon
- Site Agence Nationale de Recherche sur le Sida et Maladies Infectieuses Emergentes du Cameroun, Yaoundé Central Hospital, Cameroon
| | - Tamara Tovar Sanchez
- TransVIHMI, Université de Montpellier, Institute de Recherche pour le Développement, Inserm, Montpellier, France
| | - Marwân-al-Qays Bousmah
- Aix Marseille Univ, Inserm, Institut de Recherche pour le Développement, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Institut Science de la Santé Publique d'Aix-Marseille, Marseille, France
- Université Paris Cité, Institute de Recherche pour le Développement, Inserm, Ceped, F-75006 Paris, France
| | | | - Justin Olinga
- Site Agence Nationale de Recherche sur le Sida et Maladies Infectieuses Emergentes du Cameroun, Yaoundé Central Hospital, Cameroon
| | - Eric Mimbe
- Site Agence Nationale de Recherche sur le Sida et Maladies Infectieuses Emergentes du Cameroun, Yaoundé Central Hospital, Cameroon
| | - Michel Foalem
- Site Agence Nationale de Recherche sur le Sida et Maladies Infectieuses Emergentes du Cameroun, Yaoundé Central Hospital, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Cameroon
| | - Camille Chiep
- Site Agence Nationale de Recherche sur le Sida et Maladies Infectieuses Emergentes du Cameroun, Yaoundé Central Hospital, Cameroon
| | - Serge Edimo
- Site Agence Nationale de Recherche sur le Sida et Maladies Infectieuses Emergentes du Cameroun, Yaoundé Central Hospital, Cameroon
| | - Marie Varloteaux
- Site Agence Nationale de Recherche sur le Sida et Maladies Infectieuses Emergentes du Cameroun, Yaoundé Central Hospital, Cameroon
| | - Raphaël Pelloquin
- TransVIHMI, Université de Montpellier, Institute de Recherche pour le Développement, Inserm, Montpellier, France
| | - Nadine Lamare
- Centre de Recherches sur les Maladies Emergentes et Ré-émergentes, Yaoundé, Cameroon
| | - Sylvie Boyer
- Aix Marseille Univ, Inserm, Institut de Recherche pour le Développement, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Institut Science de la Santé Publique d'Aix-Marseille, Marseille, France
- Université Paris Cité, Institute de Recherche pour le Développement, Inserm, Ceped, F-75006 Paris, France
| | - Martine Peeters
- TransVIHMI, Université de Montpellier, Institute de Recherche pour le Développement, Inserm, Montpellier, France
| | - Jacques Reynes
- TransVIHMI, Université de Montpellier, Institute de Recherche pour le Développement, Inserm, Montpellier, France
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Alexandra Calmy
- Service des maladies infectieuses, Hôpital Universitaire de Genève, Geneva, Switzerland
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Eric Delaporte
- TransVIHMI, Université de Montpellier, Institute de Recherche pour le Développement, Inserm, Montpellier, France
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Charles Kouanfack
- Unité de prise en charge du VIH, Hôpital de District de la Cité Verte, Yaoundé, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Cameroon
- Hôpital du Jour, Hôpital Central de Yaoundé, Cameroon
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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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Bousmah MAQ, Protopopescu C, Mpoudi-Etame M, Omgba Bassega P, Maradan G, Olinga J, Varloteaux M, Tovar-Sanchez T, Delaporte É, Kouanfack C, Boyer S. Improvements in Patient-Reported Outcomes Following Initiation of Dolutegravir-Based or Low-Dose Efavirenz-Based First-Line Antiretroviral Therapy: A Four-Year Longitudinal Analysis in Cameroon (NAMSAL ANRS 12313 Trial). J Acquir Immune Defic Syndr 2023; 94:262-272. [PMID: 37851566 DOI: 10.1097/qai.0000000000003273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND We provide new and comprehensive evidence on the evolution of a wide range of patient-reported outcomes (PROs) in the NAMSAL ANRS 12313 trial in Cameroon (2016-2021)-the first randomized comparison of dolutegravir 50 mg (DTG) and low-dose efavirenz (ie, 400 mg; EFV400) in treatment-naive adults living with HIV-1 in sub-Saharan Africa. METHODS We first described the evolution of PROs between baseline and week 192. Then, we used random-effects models to measure the effect of time since the initiation of antiretroviral therapy and the differential effect of DTG versus EFV400 on each PRO, adjusting for clinical, demographic, and socioeconomic factors, while accounting for unobserved heterogeneity and missing data. RESULTS Among the 613 patients randomized (DTG arm, n = 310; EFV400 arm, n = 303), (1) physical and mental health-related quality of life improved by 13.3% and 6.8%, respectively, (2) the percentage of patients with depression, anxiety, and stress decreased from 23.3%, 23.0%, and 7.7% to 3.1%, 3.5%, and 0.4%, respectively, and (3) the mean number of HIV-related symptoms decreased from 7.2 to 3.0 ( P < 0.001). For most PROs, no significant difference was found between both arms, even when accounting for the effect of DTG on weight gain. Nevertheless, our results suggest smaller improvements in mental health outcomes in the DTG arm, with a 5 percentage point higher adjusted probability of having anxiety at week 192 ( P < 0.01). CONCLUSIONS Although supporting the current World Health Organization guidelines recommending DTG-based and EFV400-based regimens as preferred and alternative first-line antiretroviral therapy, further studies should investigate medium-term mental health outcomes in patients on DTG. TRIAL REGISTRATION ClinicalTrials.gov : NCT02777229.
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Affiliation(s)
- Marwân-Al-Qays Bousmah
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Camelia Protopopescu
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | | | | | - Gwenaëlle Maradan
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Justin Olinga
- ANRS Cameroon Site, Yaoundé Central Hospital, Yaoundé, Cameroon
| | | | - Tamara Tovar-Sanchez
- TransVIHMI, University of Montpellier, IRD-UMI233, INSERM-U1175, Montpellier, France
| | - Éric Delaporte
- TransVIHMI, University of Montpellier, IRD-UMI233, INSERM-U1175, Montpellier, France
| | - Charles Kouanfack
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Centre for Research on Emerging and Re-emerging Diseases (CREMER), Yaoundé, Cameroon; and
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Sylvie Boyer
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Yang L, Song X, Zeng W, Zheng Z, Lin W. First-line nivolumab plus ipilimumab for unresectable MPM in China: a cost-effectiveness analysis. Orphanet J Rare Dis 2023; 18:326. [PMID: 37845696 PMCID: PMC10580582 DOI: 10.1186/s13023-023-02925-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 09/24/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The regimen of nivolumab plus ipilimumab (NI) has been recommended by the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology-Malignant Pleural Mesothelioma (Version 1.2022) and Chinese Guidelines for the Clinical Diagnosis and Treatment of Malignant Pleural Mesothelioma (2021 edition) as the first-line treatment for Malignant Pleural Mesothelioma (MPM). But whether immunotherapy has a financial advantage over conventional chemotherapy (pemetrexed plus cisplatin/carboplatin, C) is uncertain. METHODS Based on survival and safety data from the CheckMate 743 clinical trial (NCT02899299), a partitioned survival model was constructed using TreeAge Pro2022 software. The model cycle was set to 1 month and the study period was 10 years. The output indicators included total cost, quality-adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to assess the robustness of the results, considering only direct medical costs. RESULTS AND DISCUSSION The ICER for group NI versus Group C was $375,656/QALY in all randomized patients, $327,943/QALY in patients with epithelioid histology, and $115,495/QALY in patients with non-epithelioid histology. The ICERs of all three different populations all exceeded the willingness-to-pay threshold (three times the per capita gross domestic product of China in 2021). The results of univariate sensitivity analysis showed that the price of pemetrexed and nivolumab had great influence on the analysis results. The results of the probabilistic sensitivity analysis show that the probability of the NI scheme being more economical in all three different populations was 0. WHAT IS NEW AND CONCLUSION From the perspective of the Chinese healthcare system, in patients with unresectable MPM, NI has no economic advantage over C.
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Affiliation(s)
- Liu Yang
- Fudan University Shanghai Cancer Center (Xiamen), Xiamen, 361005, China
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350100, China
| | - Xiaobing Song
- Department of Quality Management, Ganzhou Fifth People's Hospital, Ganzhou, 341000, China
| | - Wanxian Zeng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350100, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, 350122, China
| | - Zhiwei Zheng
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Wenqiang Lin
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, 350100, China.
- The School of Pharmacy, Fujian Medical University, Fuzhou, 350122, China.
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5
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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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6
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Brown JA, Nsakala BL, Mokhele K, Rakuoane I, Muhairwe J, Glass TR, Amstutz A, Tschumi N, Belus JM, Klimkait T, Labhardt ND. Dolutegravir in real life: Self-reported mental and physical health outcomes after transitioning from efavirenz- to dolutegravir-based antiretroviral therapy in a prospective cohort study in Lesotho. HIV Med 2023; 24:153-162. [PMID: 35730213 DOI: 10.1111/hiv.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION HIV programmes across many countries in Africa have recently transitioned people living with HIV from efavirenz (EFV)- to dolutegravir (DTG)-containing antiretroviral therapy (ART). As both drugs are associated with neuropsychiatric adverse effects, this study assessed the mental health and HIV/ART-associated symptoms of people living with HIV before and after transition to DTG. METHODS The prospective DO-REAL cohort enrolled people starting DTG-based ART in Lesotho from February to December 2020. For this analysis within DO-REAL, we included adults changing from tenofovir disoproxil fumarate (TDF)/lamivudine (3TC)/EFV to TDF/3TC/DTG within first-line therapy. At transition and 16 weeks thereafter, participants completed the Patient Health Questionnaire-9 (PHQ-9; depression screening), the 12-item Short-Form Health Survey (SF-12; mental and physical health), and a modified HIV Symptom Index (mHSI; HIV/ART-related symptoms). We also assessed weight change. We used McNemar tests with Bonferroni corrections to assess binary outcomes. CLINICALTRIALS gov: NCT04238767. RESULTS Among 1228 participants, 1131 completed follow-up. Of these, 60.0% were female, the median age was 46 years (interquartile range [IQR] 38-55), and the median time taking ART was 5.7 years (IQR 3.5-8.9). No change was observed for weight or overall PHQ-9 or SF-12 outcomes. However, three mHSI items decreased at follow-up: 'feeling sad/down/depressed' (bothered 6.0% vs. 3.3% of participants at least 'a little' before vs. after transition; adjusted p = 0.048); 'feeling nervous/anxious' (7.4% vs. 3.4%; adjusted p = 0.0009); and 'nightmares, strange/vivid dreams' (6.3% vs. 3.5%; adjusted p = 0.027). Individual PHQ-9 or SF-12 items also improved. Being symptom free across all measures increased from 5.1% to 11.4% (p < 0.0001). CONCLUSIONS We observed no negative impacts and potential moderate improvements with DTG, providing further support for the rollout of DTG.
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Affiliation(s)
- Jennifer A Brown
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Molecular Virology Group, Department of Biomedicine, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Kuena Mokhele
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | | | | | - Tracy R Glass
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Alain Amstutz
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,University Hospital Basel, Basel, Switzerland
| | - Nadine Tschumi
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennifer M Belus
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,University of Maryland, College Park, Maryland, USA
| | - Thomas Klimkait
- Molecular Virology Group, Department of Biomedicine, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Niklaus D Labhardt
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,University Hospital Basel, Basel, Switzerland
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Yang L, Cao X, Li N, Zheng B, Liu M, Cai H. Cost-effectiveness analysis of nivolumab plus ipilimumab versus chemotherapy as the first-line treatment for unresectable malignant pleural mesothelioma. Ther Adv Med Oncol 2022; 14:17588359221116604. [PMID: 35958872 PMCID: PMC9358333 DOI: 10.1177/17588359221116604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: This study evaluated the cost-effectiveness of nivolumab plus ipilimumab (NI)
versus pemetrexed plus cisplatin/carboplatin (C) as the
first-line treatment for unresectable malignant pleural mesothelioma (MPM)
from the perspective of US payers. Methods: A 10-year partitioned survival model was constructed using survival and
safety data from the CheckMate 743 clinical trial. The output metrics of the
model included the patient’s lifetime quality-adjusted life years (QALYs),
lifetime costs, and incremental cost-effectiveness ratio (ICER). Only direct
medical costs were considered. One-way and probabilistic sensitivity
analyses were conducted to assess the robustness of the results. Results: Among all randomized patients, group NI had an ICER of $475,677/QALY relative
to group C. Among patients with epithelioid histology, group NI had an ICER
of $760,955/QALY. Among patients with non-epithelioid histology, group NI
had an ICER of $418,348/QALY. The ICERs of all three populations exceeded
the willingness-to-pay threshold ($150,000). The results of one-way
sensitivity analysis revealed that the cost of nivolumab had a great
influence on the results. The results of probabilistic sensitivity analysis
demonstrated that the possibility of NI being more economical in all
randomized patients and in patients with non-epidemiology histology was 0.
In patients with epithelioid histology, the probability that NI had an
economic advantage was 0.6%. Conclusions: From the perspective of US payers, in patients with unresectable MPM, NI has
no economic advantage over C.
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Affiliation(s)
- Liu Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xueqiong Cao
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road 29, Fuzhou 350100, China
| | - Hongfu Cai
- Department of Pharmacy, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road 29, Fuzhou 350100, China
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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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