Costs and cost-efficacy analysis of the preferred treatments by GESIDA/National plan for AIDS for the initial antiretroviral therapy in adult human Immunodeficiency virus (HIV) infected patients in 2012
Por:
Blasco, AJ, Arribas, JR, Boix, V, Clotet, B, Domingo, P, Gonzalez-Garcia, J, Knobel, H, Lopez, JC, Llibre, JM, Lozano, F, Miro, JM, Podzamczer, D, Santamaria, JM, Tuset, M, Zamora, L, Lazaro, P, Gatell, JM
Publicada:
1 jun 2012
Resumen:
Introduction: The GESIDA and National AIDS Plan panel of experts propose "preferred regimens" of anti-retroviral treatment (ART) as initial therapy in HIV infected patients for 2012. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these "preferred regimens".
Methods: Economic assessment of costs and efficiency (cost/efficacy) using decision tree analysis model. Efficacy was defined as the probability of having a viral load <50 copies/ml at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and all its consequences (adverse effects, changes of ART regime, and drug resistance analyses) during the first 48 weeks. The perspective of the analysis is that of the National Health System, considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance and determination of HLA B*5701. The setting is Spain and the costs are those of 2012. A sensitivity deterministic analysis was conducted, building three scenarios for each regime: baseline, most favourable, and most unfavourable cases.
Results: In the baseline case scenario, the cost of initiating treatment ranges from 6,895 euros for TDF/FTC + NVP to 12,067 euros for TDF/FTC + RAL. The efficacy ranges between 0.66 for ABC/3TC + LPV/r and 0.87 for TDF/FTC + RAL. Efficiency, in terms of cost/efficacy, varies between 9,387 and 13,823 euros per responder at 48 weeks, for TDF/FTC/EFV and TDF/FTC + RAL, respectively. In the most unfavourable scenario, the most efficient regime is TDF/FTC + NVP (9,742 per responder).
Conclusion: Considering the official prices of ART, the most efficient regimens are TDF/FTC/EFV (baseline case and most favourable scenarios), and TDF/FTC + NVP (most unfavourable scenario). (c) 2012 Elsevier Espana, S.L. All rights reserved.
Filiaciones:
Blasco, AJ:
TAISS, Madrid, Spain
Arribas, JR:
Hosp Univ La Paz, IdiPAZ, Unidad VIH, Serv Med Interna, Madrid, Spain
Boix, V:
Gen Hosp, Unidad Enfermedades Infecciosas, Alicante, Spain
Clotet, B:
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Unitat VIH, Fundacio Lluita Sida, E-08193 Barcelona, Spain
Domingo, P:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Serv Med Interna, E-08193 Barcelona, Spain
Gonzalez-Garcia, J:
Hosp Univ La Paz, IdiPAZ, Unidad VIH, Serv Med Interna, Madrid, Spain
Knobel, H:
Hosp del Mar, Serv Enfermedades Infecciosas, Barcelona, Spain
Lopez, JC:
Hosp Univ Gregorio Maranon, Unidad Enfermedades Infecciosas VIH, Madrid, Spain
Llibre, JM:
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Unitat VIH, Fundacio Lluita Sida, E-08193 Barcelona, Spain
Lozano, F:
Hosp Univ Valme, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Miro, JM:
Univ Barcelona, Hosp Clin IDIBAPS, Serv Enfermedades Infecciosas & Sida, Barcelona, Spain
Podzamczer, D:
Hosp Univ Bellvitge, Serv Enfermedades Infecciosas, Unidad VIH, Barcelona, Spain
Santamaria, JM:
Hosp Basurto, Serv Enfermedades Infecciosas, Bilbao, Spain
Tuset, M:
Hosp Clin Barcelona, Serv Farm, Barcelona, Spain
Zamora, L:
Univ Barcelona, Hosp Clin IDIBAPS, Serv Enfermedades Infecciosas & Sida, Barcelona, Spain
Lazaro, P:
TAISS, Madrid, Spain
Gatell, JM:
Univ Barcelona, Hosp Clin IDIBAPS, Serv Enfermedades Infecciosas & Sida, Barcelona, Spain
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