Cost-Utility Analysis of Dolutegravir- Versus Efavirenz-Based Regimens as a First-Line Treatment in Adult HIV/AIDS Patients in Ethiopia

• Published in: PharmacoEconomics - open 2021-12, Vol.5 (4), p.655-664
• Main Authors: Belay, Yared Belete, Ali, Eskinder Eshetu, Chung, Karen Y., Gebretekle, Gebremedhin Beedemariam, Sander, Beate
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adults; AIDS; Antiretroviral agents; Antiretroviral drugs; Cost analysis; Drug dosages; Drug therapy; Economic analysis; GDP; Gross Domestic Product; HIV; Human immunodeficiency virus; Low income areas; Medicine; Medicine & Public Health; Original; Original Research Article; Patients; Pharmacoeconomics and Health Outcomes; Sensitivity analysis
• ISSN: 2509-4262; 2509-4254
• DOI: 10.1007/s41669-021-00275-6

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.