Analysis of the costs and cost-effectiveness of the guidelines recommended by the 2018 GESIDA/Spanish National AIDS Plan for initial antiretroviral therapy in HIV-infected adults
Por:
Perez-Molina, JA, Martinez, E, Blasco, AJ, Arribas, JR, Domingo, P, Iribarren, JA, Knobel, H, Lazaro, P, Lopez-Aldeguer, J, Lozano, F, Marino, A, Miro, JM, Moreno, S, Negredo, E, Pulido, F, Rubio, R, Santos, J, de la Torre, J, Tuset, M, von Wichmann, MA and Gatell, JM
Publicada:
1 mar 2019
Categoría:
Microbiology (medical)
Resumen:
Background: The GESIDA/National AIDS Plan expert panel recommended preferred regimens (PR), alternative regimens (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2018. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR.
Methods: Economic assessment of costs and efficiency (cost-effectiveness) based on decision tree analyses. Effectiveness 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) over the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting was Spain and the costs correspond to those of 2018. A deterministic sensitivity 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 6788 euros for TAF/FTC/RPV (AR) to 10,649 euros for TAF/FTC + RAL (PR). The effectiveness varies from 0.82 for TAF/FTC + DRV/r (AR) to 0.91 for TAF/FTC + DTG (PR). The efficiency, in terms of cost-effectiveness, ranges from 7814 to 12,412 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TAF/FTC + RAL (PR), respectively.
Conclusion: Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TAF/FTC/RPV (AR) and TAF/FTC/EVG/COBI (AR). (C) 2018 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.
Filiaciones:
Perez-Molina, JA:
Hosp Univ Ramon & Cajal, IRYCIS, Serv Enfermedades Infecciosas, Madrid, Spain
Martinez, E:
Univ Barcelona, Serv Enfermedades Infecciosas, Hosp Clin, IDIBAPS, Barcelona, Spain
Arribas, JR:
Hosp Univ La Paz, IdiPAZ, Unidad VIH, Serv Med Interna, Madrid, Spain
Domingo, P:
Univ Lleida, Hosp Univ Arnau de Vilanova, IRB Lleida, Lleida, Spain
Univ Lleida, Hosp Univ Santa Maria, IRB Lleida, Lleida, Spain
Iribarren, JA:
Hosp Univ Donostia, Inst BioDonostia, Serv Enfermedades Infecciosas, San Sebastian, Spain
Knobel, H:
Hosp del Mar, Serv Enfermedades Infecciosas, Barcelona, Spain
Lopez-Aldeguer, J:
Hosp Univ La Fe, IISLaFe, Serv Med Interna, Valencia, Spain
Hosp Univ La Fe, IISLaFe, Unidad Enfermedades Infecciosas, Valencia, Spain
Lozano, F:
Hosp Univ Valme, Unidad Clin Enfermedades Infecciosas & Microbiol, Seville, Spain
Marino, A:
Complejo Hosp Univ Ferrol, Unidad Enfermedades Infecciosas, La Coruna, Spain
Miro, JM:
Univ Barcelona, Serv Enfermedades Infecciosas, Hosp Clin, IDIBAPS, Barcelona, Spain
Moreno, S:
Univ Alcala de Henares, Inst Invest Sanitaria Ramon & Cajal IRYCIS, Hosp Raman & Cajal, Serv Enfermedades Infecciosas, Madrid, Spain
:
Fundacio Lluita SIDA, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Barcelona, Spain
Univ Cent Catalunya, Univ Vic, Barcelona, Spain
Pulido, F:
UCM, Unidad VIH, Hosp Univ 12 Octubre, Madrid, Spain
Rubio, R:
UCM, Unidad VIH, Hosp Univ 12 Octubre, Madrid, Spain
Santos, J:
Hosp Univ Virgen de la Victoria, Unidad Gest Clin Enfermedades Infecciosas, Malaga, Spain
Inst Invest Biomed Malaga IBIMA, Malaga, Spain
de la Torre, J:
Hosp Costa Del Sol, Unidad Med Interna, Grp Enfermedades Infecciosas, Malaga, Spain
Tuset, M:
Hosp Clin Barcelona, Serv Farm, Barcelona, Spain
von Wichmann, MA:
Hosp Univ Donostia, Serv Enfermedades Infecciosas, San Sebastian, Spain
Gatell, JM:
Univ Barcelona, Serv Enfermedades Infecciosas, Hosp Clin, IDIBAPS, Barcelona, Spain
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