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2015 ; 4
(3
): 337-53
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gab.com Text
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English Wikipedia
Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Naive and
Treatment-Experienced Patients in Canada
#MMPMID26099626
Despiégel N
; Anger D
; Martin M
; Monga N
; Cui Q
; Rocchi A
; Pulgar S
; Gilchrist K
; Refoios Camejo R
Infect Dis Ther
2015[Sep]; 4
(3
): 337-53
PMID26099626
show ga
INTRODUCTION: The Antiretroviral Analysis by Monte Carlo Individual Simulation
(ARAMIS) model was adapted to evaluate the cost-effectiveness of dolutegravir
(DTG) in Canada in treatment-naive (TN) and treatment-experienced (TE) human
immunodeficiency virus (HIV)-1 patients. METHODS: The ARAMIS-DTG model is a
microsimulation model with a lifetime analytic time horizon and a monthly cycle
length. Markov health states were defined by HIV health state (with or without
opportunistic infection). DTG was compared to efavirenz (EFV), raltegravir (RAL),
darunavir/ritonavir, rilpivirine (RPV), elvitegravir/cobicistat,
atazanavir/ritonavir and lopinavir/ritonavir in TN patients and to RAL in TE
patients. The initial cohort, the main efficacy data and safety data were derived
from phase III clinical trials. Treatment algorithms were based on expert
opinion. Costs normalized to the year 2013 included antiretroviral treatment
cost, testing, adverse event, HIV and cardiovascular disease care and were
derived from the literature. RESULTS: Dolutegravir was estimated to be the
dominant strategy compared with all comparators in both TN and TE patients.
Treatment with DTG was associated with additional quality-adjusted life-years
that ranged from 0.17 (vs. RAL) to 0.47 (vs. EFV) in TN patients and was 0.60 in
TE patients over a lifetime. Cost savings ranged from Can$1393 (vs. RPV) to
Can$28,572 (vs. RAL) in TN patients and amounted to Can$3745 in TE patients.
Sensitivity analyses demonstrated the robustness of the model. CONCLUSIONS:
Dolutegravir is a dominant strategy in the management of TN and TE patients when
compared to recommended comparators. This is mainly related to the high efficacy
and high barrier to resistance. FUNDING: ViiV Healthcare.
free
free
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