Cost–effectiveness of initial antiretroviral treatment administered as single vs. multiple tablet regimens with the same or different components

Josep M. Llibre, Elisa de Lazzari, Jean Michel Molina, Sébastien Gallien, Juan Gonzalez-García, Arkaitz Imaz, Daniel Podzamczer, Bonaventura Clotet, Pere Domingo, Josep M. Gatell

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2 Citations (Scopus)

Abstract

© 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica Objective To evaluate the efficiency of single-tablet regimens (STR) and multiple-tablet regimens (MTR) with exactly the same or different components. Methods A study was conducted on HIV-1-infected antiretroviral-naïve patients from 6 Spanish or French centers, who were started on treatment with STR-Atripla ® , or the same components separately (MTR-SC), or a different MTR (MTR-Other). Effectiveness was measured as percentage of HIV-RNA <50 copies/mL at 48 weeks (ITT). Efficiency was the ratio between costs (direct cost of antiretrovirals plus outpatient visits, hospital admissions, and resistance tests) and effectiveness. Results The study included a total of 2773 patients (759 STR-Atripla ® , 483 MTR-SC, and 1531 MTR-Other). Median age was 37 years, 15% were HCV co-infected, 27% had a CD4+ count <200 cells/μL, and 30% had viral load ≥100.000 copies/mL. The duration of the assigned treatment was longer for STR-Atripla ® (P <.0001). Response rates (adjusted for CD4+ count, viral load, and clustered on hospitals) at 48 weeks were 76%, 74%, and 62%, respectively (P <.0001). Virological failure was more common in MTR patients (P =.0025), and interruptions due to intolerance with MTR-Other (P <.0001). Cost per responder at 48 weeks (efficiency) was €12,406 with STR-Atripla ® , €11,034 with MTR-SC (0.89 [0.82, 0.99] times lower), and €18,353 (1.48 [1.38, 1.61] times higher) with MTR-Other. Conclusions STR-Atripla ® and MTR-SC regimens showed similar effectiveness, but virological failure rate was lower with STR-Atripla. MTR-SC, considered less convenient, had a marginally better efficiency, mainly due to lower direct costs. MTR-Other regimens had both a worse effectiveness and efficiency. Similar efficiency analyses adjusting for baseline characteristics should be recommended for new STRs.
Original languageEnglish
Pages (from-to)16-20
JournalEnfermedades Infecciosas y Microbiologia Clinica
Volume36
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • Antiretroviral treatment
  • Cost–effectiveness
  • Fixed-dose combinations
  • Single tablet regimens

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