Cost‐effectiveness evaluation of initial HAART regimens for managing HIV‐infected patients according to real clinical practice

摘要

We evaluated the single‐tablet regimen (STR) versus multiple‐tablet regimen (MTR) strategies through an incremental cost‐effectiveness analysis in a large cohort of patients starting their first HAART. Adult HIV‐1‐na?ve patients, followed at the San Raffaele Hospital, starting their first‐line regimen from June 2008 to April 2012, were included in the analysis. First‐line HAART regimens more frequently used (>10%) were grouped into two classes as follows: a) single‐tablet regimen (STR) of TDF + FTC + EFV; b) multiple‐tablet regimen (MTR) including TDF + FTC + EFV, TDF + FTC + ATV/r, TDF + FTC + DRV/r TDF + FTC + LPV/r. The incremental cost‐effectiveness analysis was carried out by means of a Markov model calculating quality of life and costs for each patient, according to the given regimen (including any subsequent switch if occurred), through 1‐year cycles. The outcome measure was quality‐adjusted life‐years (QALYs). Data were analysed from the point of view of the Lombardy Regional Health Service (RHS): HAART, hospitalisations, visits, examinations and other concomitant non‐HAART drugs costs were evaluated, price variations included. 474 na?ve patients: 90% males, mean age 42.2 years, mean baseline HIV‐RNA 4.50 log₁₀copies/ml and CD4+ count of 310 cells/μL with a mean follow‐up of 28 months. Patients starting with an STR treatment were less frequently HCVAb positive (4% vs 11%, P=0.040), had higher mean CD4+ values [351 vs 297, P=0.004] as compared to MTR patients. The mean year cost/patient was €9,213 (range: €6,574.71–€33,570.00) with a mean per patient QALYs of 0.986 (range: 0.878–0.999) among STR patients; the mean year cost/patient was €14,277 (range: €5,908.89–€82,310.30) with a mean QALY of 0.933 (0.830–0.976) among MTR patients. STR dominates (i.e. is more effective and less costly) compared to MTR. (Fig. 1) At multivariable analysis, after adjustment for age, gender, HCVAb status, HIV risk factor, baseline CD4+ and HIV‐RNA, the cost‐effectiveness ratio was significantly lower among patients starting an STR treatment as compared to a MTR regimen (adjusted mean: €12,096 vs. €16,106; P=0.0001). The incremental cost‐effectiveness ratio (ICER) values comparing the two treatment strategies reported in the table. Starting with a first‐line STR regimen compared to multiple‐tablet regimens resulted cost‐effective showing lower costs and better efficacy as measured by QALYs. Figure 1 Open in figure viewer PowerPoint Incremental Cost Effectiveness Ratio of HAART Regimens. Caption Incremental Cost Effectiveness Ratio of HAART Regimens.