TY - JOUR
T1 - Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa
AU - for the 2-Lady Group
AU - Boyer, S.
AU - Nishimwe, M. L.
AU - Sagaon-Teyssier, L.
AU - March, L.
AU - Koulla-Shiro, S.
AU - Bousmah, M. Q.
AU - Toby, R.
AU - Mpoudi-Etame, M. P.
AU - Ngom Gueye, N. F.
AU - Sawadogo, A.
AU - Kouanfack, C.
AU - Ciaffi, L.
AU - Spire, B.
AU - Delaporte, E.
AU - Ndour, C. T.
AU - Le Moing, V.
AU - Reynes, J.
AU - Calmy, A.
AU - Girard, P. M.
AU - Eholie, S.
AU - Chaix, M. L.
AU - Tita, I.
AU - Bazin, B.
AU - Garcia, P.
AU - Guiard-Schmid, J. B.
AU - Izard, S.
AU - Eymard-Duvernay, S.
AU - Peeters, M.
AU - Serrano, L.
AU - Cournil, A.
AU - Diallo, I.
AU - Mben, J. M.
AU - Manga, N.
AU - Ayangma, L.
AU - Taman, B.
AU - Kabore, F. N.
AU - Kamboule, E.
AU - Zoungrana, J.
AU - Diouf, A.
AU - Diallo, M.
AU - Fortes, L.
AU - Batista, G.
AU - Aghokeng, A.
AU - Guichet, E.
AU - Abessolo, H.
AU - Essomba, C.
AU - Manirakiza, G.
AU - Essomba, F.
AU - Mbarga, T.
AU - Epanda, S.
N1 - Publisher Copyright:
© 2019, The Author(s).
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background: While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle-income countries. We assessed the cost-effectiveness of three alternative bPI-based second-line regimens in Burkina Faso, Cameroon and Senegal. Methods: We used data collected over 2010–2015 in the 2LADY trial/post-trial cohort. Patients with first-line antiretroviral therapy (ART) failure were randomly assigned to tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r; arm A), abacavir + didanosine + lopinavir/ritonavir (arm B), or tenofovir/emtricitabine + darunavir/ritonavir (arm C). Costs (US dollars, 2016), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were computed for each country over 24 months of follow-up and extrapolated to 5 years using a simulated patient-level Markov model. We assessed uncertainty using cost-effectiveness acceptability curves, scenarios and prices threshold analysis. Results: In each country, over 24 months, arm A was significantly less costly than arms B and C (incremental costs ranging from US$410–$US721 and US$468–US$546 for B and C vs A, respectively) and offered similar health benefits (incremental QALY: − 0.138 to 0.023 and − 0.179 to 0.028, respectively). Over 5 years, arm A remained the least costly, health benefits not being significantly different between arms. Compared with arms B and C, in each study country, Arm A had a ≥ 95% probability of being cost-effective for a large range of cost-effectiveness thresholds, irrespective of the scenario considered. Conclusions: Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries. Trial Registration: ClinicalTrials.gov Identifier: NCT00928187.
AB - Background: While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle-income countries. We assessed the cost-effectiveness of three alternative bPI-based second-line regimens in Burkina Faso, Cameroon and Senegal. Methods: We used data collected over 2010–2015 in the 2LADY trial/post-trial cohort. Patients with first-line antiretroviral therapy (ART) failure were randomly assigned to tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r; arm A), abacavir + didanosine + lopinavir/ritonavir (arm B), or tenofovir/emtricitabine + darunavir/ritonavir (arm C). Costs (US dollars, 2016), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were computed for each country over 24 months of follow-up and extrapolated to 5 years using a simulated patient-level Markov model. We assessed uncertainty using cost-effectiveness acceptability curves, scenarios and prices threshold analysis. Results: In each country, over 24 months, arm A was significantly less costly than arms B and C (incremental costs ranging from US$410–$US721 and US$468–US$546 for B and C vs A, respectively) and offered similar health benefits (incremental QALY: − 0.138 to 0.023 and − 0.179 to 0.028, respectively). Over 5 years, arm A remained the least costly, health benefits not being significantly different between arms. Compared with arms B and C, in each study country, Arm A had a ≥ 95% probability of being cost-effective for a large range of cost-effectiveness thresholds, irrespective of the scenario considered. Conclusions: Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries. Trial Registration: ClinicalTrials.gov Identifier: NCT00928187.
UR - https://www.scopus.com/pages/publications/85096815356
U2 - 10.1007/s41669-019-0157-9
DO - 10.1007/s41669-019-0157-9
M3 - Artículo
AN - SCOPUS:85096815356
SN - 2509-4262
VL - 4
SP - 45
EP - 60
JO - PharmacoEconomics - Open
JF - PharmacoEconomics - Open
IS - 1
ER -
SDG 3 Good Health and Well-being