Analysis of costs and cost-effectiveness of preferred GESIDA/National AIDS Plan regimens for initial antiretroviral therapy in human immunodeficiency virus infected adult patients in 2013
Por:
Blasco, AJ, Llibre, JM, Arribas, JR, Boix, V, Clotet, B, Domingo, P, Gonzalez-Garcia, J, Knobel, H, Lopez, JC, Lozano, F, Miro, JM, Podzamczer, D, Santamaria, JM, Tuset, M, Zamora, L, Lazaro, P, Gatell, JM
Publicada:
1 nov 2013
Resumen:
Introduction: The GESIDA and National AIDS Plan panel of experts have proposed "preferred regimens" of antiretroviral treatment (ART) as initial therapy in HIV infected patients for 2013. The objective of this study is to evaluate the costs and effectiveness of initiating treatment with these "preferred regimens".
Methods: An economic assessment of costs and effectiveness (cost/effectiveness) was performed using decision tree analysis models. Effectiveness was defined as the probability of having 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 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 was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, resistance studies, and determination of HLA B*5701. The setting is Spain and the costs are those of 2013. A sensitivity deterministic analysis was performed, constructing three scenarios for each regimen: baseline, most favourable, and most unfavourable cases.
Results: In the baseline case scenario, the cost of initiating treatment ranges from 6,747 euros for TDF/FTC+NVP to 12,059 euros for TDF/FTC+RAL. The effectiveness ranges between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.87 for TDF/FTC+RAL and ABC/3TC+RAL. Effectiveness, in terms of cost/effectiveness, varies between 8,396 euros and 13,930 euros per responder at 48 weeks, for TDF/FTC/RPV and TDF/FTC+RAL, respectively.
Conclusions: Taking ART at official prices, the most effective regimen was TDF/FTC/RPV, followed by the rest of non-nucleoside containing regimens. The sensitivity analysis confirms the robustness of these findings. (C) 2013 Elsevier Espana, S.L. All rights reserved.
Filiaciones:
Blasco, AJ:
Tecn Avanzadas Invest Serv Salud, Madrid, Spain
Llibre, JM:
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Fundacio Lluita Sida, Unitat VIH, E-08193 Barcelona, Spain
Arribas, JR:
Hosp Univ La Paz, IdiPAZ, Med Interna Serv, Unidad VIH, Madrid, Spain
Boix, V:
Hosp Gen Alicante, Unidad Enfermedades Infecciosas, Alicante, Spain
Clotet, B:
Univ Autonoma Barcelona, Hosp Univ Germans Trias & Pujol, Fundacio Lluita Sida, Unitat VIH, E-08193 Barcelona, Spain
Domingo, P:
Univ Autonoma Barcelona, Hosp Santa Creu & Sant Pau, E-08193 Barcelona, Spain
Gonzalez-Garcia, J:
Hosp Univ La Paz, IdiPAZ, Med Interna Serv, Unidad VIH, Madrid, Spain
Knobel, H:
Hosp Mar, Serv Enfermedades Infecciosas, Barcelona, Spain
Lopez, JC:
Hosp Univ Gregorio Maranon, Unidad Enfermedades Infecciosas VIH, Madrid, 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:
Tecn Avanzadas Invest Serv Salud, Madrid, Spain
Gatell, JM:
Univ Barcelona, Hosp Clin IDIBAPS, Serv Enfermedades Infecciosas & Sida, Barcelona, Spain
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