An Economic Evaluation Of Single Tablet Regimens Of Antiretroviral Therapy For Treatment-Naitve Hiv-Infected Patients

• Published in: Value in health 2017-10, Vol.20 (9), p.A932
• Main Authors: Chou, C, Terris-Prestholt, F, Miners, A
• Format: Article
• Language: English
• Subjects: Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Cost analysis; Efavirenz; Efficacy; Emtricitabine; Epidemics; Health care expenditures; HIV; Human immunodeficiency virus; Infections; Life expectancy; Life span; Medical treatment; Patients; Quality adjusted life years; Sensitivity analysis; Short tandem repeats; Stochasticity; Tenofovir; Uncertainty; Utility functions; Willingness to pay
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.2920

OBJECTIVES: Antiretroviral therapy (ART) has considerably changed the life expectancy and life quality of HIV-infected patients. However, uprising epidemic of HIV infection and the new recommendation of early ART initiation cause a heavy financial burden. Cost-effectiveness of ART should consequently be considered. Single-tablet regimen (STR), one pill that contains a combination of multiple antiretroviral agents, is a recent advance in HIV treatment and widely used now. The objective of this study is to perform a cost-utility analysis of STR using a decision model to assess the cost-effectiveness of tenofovir disoproxil fumarate/ emtricitabine/rilpivirine (TDF/FTC/RPV) compared to tenofovir disoproxil fumarate/ emtricitabine/efavirenz (TDF/FTC/EFV) for asymptomatic, treatment-naive HIV-infected patients. METHODS: A Markov model with a hypothetical cohort of 1000 HIV-infected patients having initial viral load < 100,000 copies/ml was designed. Quality-adjusted life year (QALY) was used as the health outcome and incremental cost-effectiveness ratio (ICER) comparing the two STRs was calculated. The willingness-to-pay (WTP) threshold of 70000USD was adopted. Most of the parameters in the model were considered stochastic, and the uncertainty was taken into account by deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA). RESULTS: The calculated ICER per QALY was 13521.6USD. In terms of uncertainty, the ICER was sensitive to all parameters in the model. DSA showed that the most significant parameter of transition probability was the treatment efficacy of the two STRs. The utility in the first cycle and the costs of two STRs were also found influential. PSA demonstrated that the probability of cost-effectiveness was 61% at the WTP of 70000USD. CONCLUSIONS: The ICER per QALY (13521.6USD) of TDF/FTC/RPV to TDF/FTC/EFV comprised a relatively small fraction of the adopted WTP (70000USD), but there was significant uncertainty coming from the treatment efficacy and costs. TDF/FTC/RPV maybe more cost-effective compared toTDF/FTC/ EFV for treatment-naive HIV-infected patients.