Costs and cost-efficacy analysis of the 2014 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults

Antonio Javier Blasco, Josep M. Llibre, Juan Berenguer, Juan González-García, Hernando Knobel, Fernando Lozano, Daniel Podzamczer, Federico Pulido, Antonio Rivero, Montserrat Tuset, Pablo Lázaro, Josep M. Gatell

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved. INTRODUCTION: GESIDA and the National AIDS Plan panel of experts suggest preferred (PR) and alternative (AR) regimens of antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2014. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these regimens.METHODS: An economic assessment was made of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied by considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and costs correspond to those of 2014. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable.RESULTS: In the base case scenario, the cost of initiating treatment ranges from 5133 Euros for ABC/3TC+EFV to 11,949 Euros for TDF/FTC+RAL. The efficacy varies between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.89 for TDF/FTC/EVG/COBI. Efficiency, in terms of cost/efficacy, ranges from 7546 to 13,802 Euros per responder at 48 weeks, for ABC/3TC+EFV and TDF/FTC+RAL respectively.CONCLUSION: Considering ART official prices, the most efficient regimen was ABC/3TC+EFV (AR), followed by the non-nucleoside containing PR (TDF/FTC/RPV and TDF/FTC/EFV). The sensitivity analysis confirms the robustness of these findings.
    Original languageEnglish
    Pages (from-to)156-165
    JournalEnfermedades Infecciosas y Microbiologia Clinica
    Volume33
    Issue number3
    DOIs
    Publication statusPublished - 1 Mar 2015

    Keywords

    • AIDS
    • Antiretrovirals
    • Antirretrovirales
    • Cost
    • Costes
    • Efficacy
    • Efficiency
    • Eficacia
    • Eficiencia
    • HIV
    • Sida
    • Therapy
    • Tratamiento
    • VIH

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