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Cost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients
Abstract Objective: The aim of this study was to compare the cost per unit of effectiveness (successful treatment episode) of 2 highly active antiretroviral therapy combinations–emtricitabine/tenofovir DF + efavirenz (TVD + EFV) and lamivudine/zidovudine + efavirenz (COMB + EFV)–in antiretroviral-na...
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| Published in: | Clinical therapeutics 2008-02, Vol.30 (2), p.372-381 |
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| container_title | Clinical therapeutics |
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| creator | Sánchez-de la Rosa, Rainel, MD, PhD Herrera, Luis, MD Moreno, Santiago, MD, PhD |
| description | Abstract Objective: The aim of this study was to compare the cost per unit of effectiveness (successful treatment episode) of 2 highly active antiretroviral therapy combinations–emtricitabine/tenofovir DF + efavirenz (TVD + EFV) and lamivudine/zidovudine + efavirenz (COMB + EFV)–in antiretroviral-naive, HIV-1-infected patients from the perspective of costs to society. Methods: This cost-effectiveness analysis was modeled using a decision tree that considered the therapeutic response (successful treatment episode, ie, HIV-1 RNA |
| doi_str_mv | 10.1016/j.clinthera.2008.02.009 |
| format | article |
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Methods: This cost-effectiveness analysis was modeled using a decision tree that considered the therapeutic response (successful treatment episode, ie, HIV-1 RNA <400 copies/mL using data obtained directly from a clinical trial) and the switch to rescue therapy in nonresponders. The time horizon was 24 months of treatment. Cost was defined as direct medical costs (drugs, diagnostic and/or laboratory tests, treatment of adverse effects) and indirect medical costs (productivity losses). All data are presented as €(2005). Sensitivity analysis was 1-factor threshold, adjustment of ex-factory cost, only direct costs, and applying discount rate in the study. The results are presented as incremental costs, success rates, and cost per patient with undetectable viral load or additional success. Results: The expected 48-week cost of the regimen that includes TVD + EFV was €46,464, and for the regimen that included COMB + EFV, €56,198. Therefore, savings of €9734 were achieved for each patient treated with TVD + EFV, as well as a gain of 13% of patients with undetectable viral load after 24 months of treatment. Consequently, treatment with TVD + EFV combination would be dominant in therapy for antiretroviral-naive, HIV-1-infected patients. Sensitivity tests supported the stability of the base-case analysis. The cost-effectiveness ratios were €619.52 for the TVD + EFV regimen versus €906.41 for the COMB + EFV regimen. Conclusion: Based on the results of this analysis, patients who started treatment of HIV-1 infection with combination TVD + EFV had significantly lower health care resource utilization and overall treatment costs compared with the COMB + EFV combination.</description><identifier>ISSN: 0149-2918</identifier><identifier>EISSN: 1879-114X</identifier><identifier>DOI: 10.1016/j.clinthera.2008.02.009</identifier><identifier>PMID: 18343275</identifier><language>eng</language><publisher>Bridgewater, NJ: EM Inc USA</publisher><subject>Adenine - analogs & derivatives ; Adenine - economics ; Adenine - therapeutic use ; Anti-HIV Agents - economics ; Anti-HIV Agents - therapeutic use ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiretroviral Therapy, Highly Active ; Antiviral agents ; Benzoxazines - economics ; Benzoxazines - therapeutic use ; Biological and medical sciences ; cost analysis ; Cost-Benefit Analysis ; Decision Trees ; Deoxycytidine - analogs & derivatives ; Deoxycytidine - economics ; Deoxycytidine - therapeutic use ; Drug Costs ; Emtricitabine ; HAART ; Health Care Costs ; Health Resources - economics ; Health Resources - utilization ; HIV Infections - drug therapy ; HIV Infections - economics ; HIV Infections - virology ; HIV-1 ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infectious diseases ; Internal Medicine ; Lamivudine - economics ; Lamivudine - therapeutic use ; Medical Education ; Medical sciences ; Models, Economic ; nucleoside-analogue reverse transcriptase inhibitors ; Organophosphonates - economics ; Organophosphonates - therapeutic use ; Pharmacology. Drug treatments ; Reverse Transcriptase Inhibitors - economics ; Reverse Transcriptase Inhibitors - therapeutic use ; Tenofovir ; Time Factors ; Treatment Outcome ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Zidovudine - economics ; Zidovudine - therapeutic use</subject><ispartof>Clinical therapeutics, 2008-02, Vol.30 (2), p.372-381</ispartof><rights>Excerpta Medica Inc. All rights reserved.</rights><rights>2008 Excerpta Medica Inc. All rights reserved.</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-d2cbdf0aa97002ce55c88b8464c224f3892f97ffdcab1a4b2d5a7bf81bd604da3</citedby><cites>FETCH-LOGICAL-c397t-d2cbdf0aa97002ce55c88b8464c224f3892f97ffdcab1a4b2d5a7bf81bd604da3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21012013$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18343275$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sánchez-de la Rosa, Rainel, MD, PhD</creatorcontrib><creatorcontrib>Herrera, Luis, MD</creatorcontrib><creatorcontrib>Moreno, Santiago, MD, PhD</creatorcontrib><title>Cost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients</title><title>Clinical therapeutics</title><addtitle>Clin Ther</addtitle><description>Abstract Objective: The aim of this study was to compare the cost per unit of effectiveness (successful treatment episode) of 2 highly active antiretroviral therapy combinations–emtricitabine/tenofovir DF + efavirenz (TVD + EFV) and lamivudine/zidovudine + efavirenz (COMB + EFV)–in antiretroviral-naive, HIV-1-infected patients from the perspective of costs to society. Methods: This cost-effectiveness analysis was modeled using a decision tree that considered the therapeutic response (successful treatment episode, ie, HIV-1 RNA <400 copies/mL using data obtained directly from a clinical trial) and the switch to rescue therapy in nonresponders. The time horizon was 24 months of treatment. Cost was defined as direct medical costs (drugs, diagnostic and/or laboratory tests, treatment of adverse effects) and indirect medical costs (productivity losses). All data are presented as €(2005). Sensitivity analysis was 1-factor threshold, adjustment of ex-factory cost, only direct costs, and applying discount rate in the study. The results are presented as incremental costs, success rates, and cost per patient with undetectable viral load or additional success. Results: The expected 48-week cost of the regimen that includes TVD + EFV was €46,464, and for the regimen that included COMB + EFV, €56,198. Therefore, savings of €9734 were achieved for each patient treated with TVD + EFV, as well as a gain of 13% of patients with undetectable viral load after 24 months of treatment. Consequently, treatment with TVD + EFV combination would be dominant in therapy for antiretroviral-naive, HIV-1-infected patients. Sensitivity tests supported the stability of the base-case analysis. The cost-effectiveness ratios were €619.52 for the TVD + EFV regimen versus €906.41 for the COMB + EFV regimen. Conclusion: Based on the results of this analysis, patients who started treatment of HIV-1 infection with combination TVD + EFV had significantly lower health care resource utilization and overall treatment costs compared with the COMB + EFV combination.</description><subject>Adenine - analogs & derivatives</subject><subject>Adenine - economics</subject><subject>Adenine - therapeutic use</subject><subject>Anti-HIV Agents - economics</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Antiviral agents</subject><subject>Benzoxazines - economics</subject><subject>Benzoxazines - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Decision Trees</subject><subject>Deoxycytidine - analogs & derivatives</subject><subject>Deoxycytidine - economics</subject><subject>Deoxycytidine - therapeutic use</subject><subject>Drug Costs</subject><subject>Emtricitabine</subject><subject>HAART</subject><subject>Health Care Costs</subject><subject>Health Resources - economics</subject><subject>Health Resources - utilization</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - economics</subject><subject>HIV Infections - virology</subject><subject>HIV-1</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infectious diseases</subject><subject>Internal Medicine</subject><subject>Lamivudine - economics</subject><subject>Lamivudine - therapeutic use</subject><subject>Medical Education</subject><subject>Medical sciences</subject><subject>Models, Economic</subject><subject>nucleoside-analogue reverse transcriptase inhibitors</subject><subject>Organophosphonates - economics</subject><subject>Organophosphonates - therapeutic use</subject><subject>Pharmacology. Drug treatments</subject><subject>Reverse Transcriptase Inhibitors - economics</subject><subject>Reverse Transcriptase Inhibitors - therapeutic use</subject><subject>Tenofovir</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>Zidovudine - economics</subject><subject>Zidovudine - therapeutic use</subject><issn>0149-2918</issn><issn>1879-114X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNqNkt9u2yAYxdG0aU2zvcKGNG1XdQrYieGmUhVta6VKu9gf7Q5h-FDJbMgAZ0qfpw86vESt1KtdGYvfOcA5H0JvKVlQQlfnm4Xunc-3ENWCEcIXhC0IEc_QjPJWVJQ2P5-jGaGNqJig_ASdprQhhNRiyV6iE8rrpmbtcobu1yHlCqwFnd0OPKSElVf9PrmEg8Uw5Oi0y6pzHs4z-GDDzkW8g5jGhHs1uN1opr07Z8JheYadxzoMRaKyCx7_cfkWg1VFCP7u37byufzkOJmpvvKqHH6Gr65_VLRyfroNGLwtcvA5vUIvrOoTvD5-5-j7p4_f1lfVzZfP1-vLm0rXos2VYbozliglWkKYhuVSc97xZtVoxhpbc8GsaK01WnVUNR0zS9V2ltPOrEhjVD1HHw6-2xh-j5CyHFzS0PfKQxiTbElDuGhXBXz3BNyEMZbYkqSkZoJxUiKeo_ZA6RhSimDlNrpBxX2B5FSj3MiHGuVUoyRMlhqL8s3Rf-wGMI-6Y28FeH8EVNKqt1F57dIDx4o7I7Qu3OWBgxLbzkGUSZdINZiSvs7SBPcfl7l44jFxrhz7C_aQHl8uUxHIr9PUTUNHeBk4wWj9Fxs12XY</recordid><startdate>200802</startdate><enddate>200802</enddate><creator>Sánchez-de la Rosa, Rainel, MD, PhD</creator><creator>Herrera, Luis, MD</creator><creator>Moreno, Santiago, MD, PhD</creator><general>EM Inc USA</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>200802</creationdate><title>Cost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients</title><author>Sánchez-de la Rosa, Rainel, MD, PhD ; Herrera, Luis, MD ; Moreno, Santiago, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c397t-d2cbdf0aa97002ce55c88b8464c224f3892f97ffdcab1a4b2d5a7bf81bd604da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adenine - analogs & derivatives</topic><topic>Adenine - economics</topic><topic>Adenine - therapeutic use</topic><topic>Anti-HIV Agents - economics</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Antiviral agents</topic><topic>Benzoxazines - economics</topic><topic>Benzoxazines - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>Decision Trees</topic><topic>Deoxycytidine - analogs & derivatives</topic><topic>Deoxycytidine - economics</topic><topic>Deoxycytidine - therapeutic use</topic><topic>Drug Costs</topic><topic>Emtricitabine</topic><topic>HAART</topic><topic>Health Care Costs</topic><topic>Health Resources - economics</topic><topic>Health Resources - utilization</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - economics</topic><topic>HIV Infections - virology</topic><topic>HIV-1</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunodeficiencies</topic><topic>Immunodeficiencies. Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Infectious diseases</topic><topic>Internal Medicine</topic><topic>Lamivudine - economics</topic><topic>Lamivudine - therapeutic use</topic><topic>Medical Education</topic><topic>Medical sciences</topic><topic>Models, Economic</topic><topic>nucleoside-analogue reverse transcriptase inhibitors</topic><topic>Organophosphonates - economics</topic><topic>Organophosphonates - therapeutic use</topic><topic>Pharmacology. Drug treatments</topic><topic>Reverse Transcriptase Inhibitors - economics</topic><topic>Reverse Transcriptase Inhibitors - therapeutic use</topic><topic>Tenofovir</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><topic>Zidovudine - economics</topic><topic>Zidovudine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sánchez-de la Rosa, Rainel, MD, PhD</creatorcontrib><creatorcontrib>Herrera, Luis, MD</creatorcontrib><creatorcontrib>Moreno, Santiago, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Health Management Database (Proquest)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sánchez-de la Rosa, Rainel, MD, PhD</au><au>Herrera, Luis, MD</au><au>Moreno, Santiago, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients</atitle><jtitle>Clinical therapeutics</jtitle><addtitle>Clin Ther</addtitle><date>2008-02</date><risdate>2008</risdate><volume>30</volume><issue>2</issue><spage>372</spage><epage>381</epage><pages>372-381</pages><issn>0149-2918</issn><eissn>1879-114X</eissn><abstract>Abstract Objective: The aim of this study was to compare the cost per unit of effectiveness (successful treatment episode) of 2 highly active antiretroviral therapy combinations–emtricitabine/tenofovir DF + efavirenz (TVD + EFV) and lamivudine/zidovudine + efavirenz (COMB + EFV)–in antiretroviral-naive, HIV-1-infected patients from the perspective of costs to society. Methods: This cost-effectiveness analysis was modeled using a decision tree that considered the therapeutic response (successful treatment episode, ie, HIV-1 RNA <400 copies/mL using data obtained directly from a clinical trial) and the switch to rescue therapy in nonresponders. The time horizon was 24 months of treatment. Cost was defined as direct medical costs (drugs, diagnostic and/or laboratory tests, treatment of adverse effects) and indirect medical costs (productivity losses). All data are presented as €(2005). Sensitivity analysis was 1-factor threshold, adjustment of ex-factory cost, only direct costs, and applying discount rate in the study. The results are presented as incremental costs, success rates, and cost per patient with undetectable viral load or additional success. Results: The expected 48-week cost of the regimen that includes TVD + EFV was €46,464, and for the regimen that included COMB + EFV, €56,198. Therefore, savings of €9734 were achieved for each patient treated with TVD + EFV, as well as a gain of 13% of patients with undetectable viral load after 24 months of treatment. Consequently, treatment with TVD + EFV combination would be dominant in therapy for antiretroviral-naive, HIV-1-infected patients. Sensitivity tests supported the stability of the base-case analysis. The cost-effectiveness ratios were €619.52 for the TVD + EFV regimen versus €906.41 for the COMB + EFV regimen. Conclusion: Based on the results of this analysis, patients who started treatment of HIV-1 infection with combination TVD + EFV had significantly lower health care resource utilization and overall treatment costs compared with the COMB + EFV combination.</abstract><cop>Bridgewater, NJ</cop><pub>EM Inc USA</pub><pmid>18343275</pmid><doi>10.1016/j.clinthera.2008.02.009</doi><tpages>10</tpages></addata></record> |
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| ispartof | Clinical therapeutics, 2008-02, Vol.30 (2), p.372-381 |
| issn | 0149-2918 1879-114X |
| language | eng |
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| source | ScienceDirect Journals |
| subjects | Adenine - analogs & derivatives Adenine - economics Adenine - therapeutic use Anti-HIV Agents - economics Anti-HIV Agents - therapeutic use Antibiotics. Antiinfectious agents. Antiparasitic agents Antiretroviral Therapy, Highly Active Antiviral agents Benzoxazines - economics Benzoxazines - therapeutic use Biological and medical sciences cost analysis Cost-Benefit Analysis Decision Trees Deoxycytidine - analogs & derivatives Deoxycytidine - economics Deoxycytidine - therapeutic use Drug Costs Emtricitabine HAART Health Care Costs Health Resources - economics Health Resources - utilization HIV Infections - drug therapy HIV Infections - economics HIV Infections - virology HIV-1 Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infectious diseases Internal Medicine Lamivudine - economics Lamivudine - therapeutic use Medical Education Medical sciences Models, Economic nucleoside-analogue reverse transcriptase inhibitors Organophosphonates - economics Organophosphonates - therapeutic use Pharmacology. Drug treatments Reverse Transcriptase Inhibitors - economics Reverse Transcriptase Inhibitors - therapeutic use Tenofovir Time Factors Treatment Outcome Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Zidovudine - economics Zidovudine - therapeutic use |
| title | Cost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients |
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