Antonio Rivero1, José Antonio Pérez-Molina2, Antonio Javier Blasco3, José Ramón Arribas4, Víctor Asensi5, Manuel Crespo6, Pere Domingo7, José Antonio Iribarren8, Pablo Lázaro9, José López-Aldeguer10, Fernando Lozano11, Esteban Martínez12, Santiago Moreno13, Rosario Palacios14, Juan Antonio Pineda11, Federico Pulido15, Rafael Rubio15, Jesús Santos16, Javier de la Torre17, Montserrat Tuset18, Josep M Gatell12. 1. Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain. 2. Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. 3. Independent Health Services Researcher, Madrid, Spain. Electronic address: antoniojblasco@hotmail.com. 4. Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain. 5. Unidad de Enfermedades Infecciosas-VIH, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain. 6. Complexo Hospitalario Universitario de Vigo, Vigo, Spain. 7. Hospitals Universitaris Arnau de Vilanova & Santa María, Universitat de Lleida, Institut de Recerca Biomèdica (IRB) de Lleida, Lleida, Spain. 8. Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain. 9. Independent Health Services Researcher, Madrid, Spain. 10. Servicio de Medicina Interna y Unidad de Enfermedades Infecciosas Hospital Universitario La Fe, IISLaFe, Valencia, Spain. 11. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain. 12. Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain. 13. Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Madrid, Spain. 14. Unidad de Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain. 15. Unidad VIH, i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain. 16. Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain. 17. Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain. 18. Servicio de Farmacia, Hospital Clínic, Barcelona, Spain.
Abstract
INTRODUCTION: GESIDA and the Spanish National AIDS Plan panel of experts have recommended preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral therapy (ART) as initial therapy in HIV-infected patients for 2017. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR. METHODS: Economic assessment of costs and efficiency (cost-efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, resistance studies and HLA B*5701 screening. The setting was Spain and the costs correspond to those of 2017. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. RESULTS: In the base case scenario, the cost of initiating treatment ranged from 6882 euro for TFV/FTC/RPV (AR) to 10,904 euros for TFV/FTC+RAL (PR). The efficacy varied from 0.82 for TFV/FTC+DRV/p (AR) to 0.92 for TAF/FTC/EVG/COBI (PR). The efficiency, in terms of cost-efficacy, ranged from 7923 to 12,765 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TFV/FTC+RAL (PR), respectively. CONCLUSION: Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TFV/FTC/RPV (AR) and TAF/FTC/EVG/COBI (PR).
INTRODUCTION: GESIDA and the Spanish National AIDS Plan panel of experts have recommended preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral therapy (ART) as initial therapy in HIV-infectedpatients for 2017. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR. METHODS: Economic assessment of costs and efficiency (cost-efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, resistance studies and HLA B*5701 screening. The setting was Spain and the costs correspond to those of 2017. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. RESULTS: In the base case scenario, the cost of initiating treatment ranged from 6882 euro for TFV/FTC/RPV (AR) to 10,904 euros for TFV/FTC+RAL (PR). The efficacy varied from 0.82 for TFV/FTC+DRV/p (AR) to 0.92 for TAF/FTC/EVG/COBI (PR). The efficiency, in terms of cost-efficacy, ranged from 7923 to 12,765 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TFV/FTC+RAL (PR), respectively. CONCLUSION: Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TFV/FTC/RPV (AR) and TAF/FTC/EVG/COBI (PR).
Authors: Julián Olalla; Javier Pérez-Stachowski; Begoña Tortajada; Alfonso Del Arco; Efrén Márquez; Javier De la Torre; Miriam Nieto; José María García de Lomas; José Luis Prada; Javier García-Alegría Journal: BMC Pharmacol Toxicol Date: 2018-10-10 Impact factor: 2.483