BACKGROUND: A key element for payers in the assessment of the economic profile of a medication is its anticipated impact on the evolution of healthcare budgets. OBJECTIVES: To forecast the impact of the use of darunavir with low-dose ritonavir 600/100 mg twice a day (bid) in highly treatment-experienced, HIV-infected adults who have failed one or more protease inhibitor (PI)-containing regimen on the budget of the French Sickness Fund (French healthcare system) over a 3-year time horizon. METHODS: A transition state model based on disease severity was developed that compared the evolution of antiretroviral and non-antiretroviral-related direct costs of care in the target population over 3 years (2007-2009) under two scenarios: (1) darunavir enters the French market in year 1; (2) darunavir is not available to the target population during 2007-2009. Model inputs were derived from a targeted analysis of the French hospital database in HIV, the darunavir POWER 1 and 2 trials and other relevant clinical studies. RESULTS: In the scenario where darunavir was available from year 1, the proportion of patients in the lower, more costly CD4 cell count strata (≤ 100 cells per mm³) was consistently lower than in the scenario without darunavir in each year of the model (17.0% vs 19.2%, 13.9% vs 18.3% and 10.8% vs 16.8% for years 1, 2 and 3, respectively). As a result, over the entire 3-year period, the net increase of antiretroviral drug costs (+ 5.6 million Euros; €), resulting from the substitution of older, cheaper PIs by darunavir, is expected to be fully compensated by savings in hospitalization costs (€-9.7 million) and expenditures for other HIV-related (non-antiretroviral) medications (€-7.3 million), leading to a net saving of €11.4 million or 2.9% of the total budget in the scenario without darunavir. Various sensitivity analyses confirmed these projected savings. CONCLUSION: The use of darunavir/ritonavir (DRV/r) 600/100 mg bid, in combination with other antiretroviral agents, in highly pre-treated, HIV-infected adults who have failed one or more PI-containing highly active antiretroviral therapy regimen is not expected to increase the budget of the French healthcare system, in comparison with a scenario without darunavir. Further research is needed to estimate the budget impact of the use of DRV/r in less treatment-experienced, HIV-infected individuals in France.
BACKGROUND: A key element for payers in the assessment of the economic profile of a medication is its anticipated impact on the evolution of healthcare budgets. OBJECTIVES: To forecast the impact of the use of darunavir with low-dose ritonavir 600/100 mg twice a day (bid) in highly treatment-experienced, HIV-infected adults who have failed one or more protease inhibitor (PI)-containing regimen on the budget of the French Sickness Fund (French healthcare system) over a 3-year time horizon. METHODS: A transition state model based on disease severity was developed that compared the evolution of antiretroviral and non-antiretroviral-related direct costs of care in the target population over 3 years (2007-2009) under two scenarios: (1) darunavir enters the French market in year 1; (2) darunavir is not available to the target population during 2007-2009. Model inputs were derived from a targeted analysis of the French hospital database in HIV, the darunavir POWER 1 and 2 trials and other relevant clinical studies. RESULTS: In the scenario where darunavir was available from year 1, the proportion of patients in the lower, more costly CD4 cell count strata (≤ 100 cells per mm³) was consistently lower than in the scenario without darunavir in each year of the model (17.0% vs 19.2%, 13.9% vs 18.3% and 10.8% vs 16.8% for years 1, 2 and 3, respectively). As a result, over the entire 3-year period, the net increase of antiretroviral drug costs (+ 5.6 million Euros; €), resulting from the substitution of older, cheaper PIs by darunavir, is expected to be fully compensated by savings in hospitalization costs (€-9.7 million) and expenditures for other HIV-related (non-antiretroviral) medications (€-7.3 million), leading to a net saving of €11.4 million or 2.9% of the total budget in the scenario without darunavir. Various sensitivity analyses confirmed these projected savings. CONCLUSION: The use of darunavir/ritonavir (DRV/r) 600/100 mg bid, in combination with other antiretroviral agents, in highly pre-treated, HIV-infected adults who have failed one or more PI-containing highly active antiretroviral therapy regimen is not expected to increase the budget of the French healthcare system, in comparison with a scenario without darunavir. Further research is needed to estimate the budget impact of the use of DRV/r in less treatment-experienced, HIV-infected individuals in France.
Authors: B Gazzard; A J Bernard; M Boffito; D Churchill; S Edwards; N Fisher; A M Geretti; M Johnson; C Leen; B Peters; A Pozniak; J Ross; J Walsh; E Wilkins; M Youle Journal: HIV Med Date: 2006-11 Impact factor: 3.180
Authors: Charles B Hicks; Pedro Cahn; David A Cooper; Sharon L Walmsley; Christine Katlama; Bonaventura Clotet; Adriano Lazzarin; Margaret A Johnson; Dietmar Neubacher; Douglas Mayers; Hernan Valdez Journal: Lancet Date: 2006-08-05 Impact factor: 79.321
Authors: Scott M Hammer; Michael S Saag; Mauro Schechter; Julio S G Montaner; Robert T Schooley; Donna M Jacobsen; Melanie A Thompson; Charles C J Carpenter; Margaret A Fischl; Brian G Gazzard; Jose M Gatell; Martin S Hirsch; David A Katzenstein; Douglas D Richman; Stefano Vella; Patrick G Yeni; Paul A Volberding Journal: JAMA Date: 2006-08-16 Impact factor: 56.272
Authors: José Valdez Madruga; Daniel Berger; Marilyn McMurchie; Fredy Suter; Denes Banhegyi; Kiat Ruxrungtham; Dorece Norris; Eric Lefebvre; Marie-Pierre de Béthune; Frank Tomaka; Martine De Pauw; Tony Vangeneugden; Sabrina Spinosa-Guzman Journal: Lancet Date: 2007-07-07 Impact factor: 79.321
Authors: Richard Haubrich; Dan Berger; Philippe Chiliade; Amy Colson; Marcus Conant; Joel Gallant; Timothy Wilkin; Jeffrey Nadler; Gerald Pierone; Michael Saag; Ben van Baelen; Eric Lefebvre Journal: AIDS Date: 2007-03-30 Impact factor: 4.177