Cost-utility analysis of a dolutegravir-based versus low-dose efavirenz-based regimen for the initial treatment of HIV-infected patients in Cameroon (NAMSAL ANRS 12313 trial)
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1 mars 2021
info:eu-repo/semantics/openAccess , http://creativecommons.org/licenses/by-nc/
Mots-clés
AIDS THERAPY COST-BENEFIT_ANALYSIS COST_ANALYSIS QUALITY_OF_LIFE CAMEROON SUB-SAHARAN_AFRICASujets proches
Probability Statistical inference Wellness Personal health Biography--HealthCiter ce document
Marwân Bousmah et al., « Cost-utility analysis of a dolutegravir-based versus low-dose efavirenz-based regimen for the initial treatment of HIV-infected patients in Cameroon (NAMSAL ANRS 12313 trial) », Archined : l'archive ouverte de l'INED, ID : 10.1007/s40273-020-00987-3
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OBJECTIVES: Evidence comparing the economic and patient values of the World Health Organization's preferred (dolutegravir 50 mg [DTG]-based) and alternative (low-dose [400 mg] efavirenz [EFV400]-based) first-line antiretroviral regimens is limited. We compared patient-reported outcomes (PROs), costs, and the cost-utility of DTG- versus EFV400-based regimens in treatment-naive HIV-1 adults in the randomised NAMSAL ANRS 12313 trial in Yaoundé, Cameroon. METHODS: We used clinical data, PROs, and health resource use data collected in the trial's first 96 weeks (2016-2019). Quality-adjusted life-years (QALYs) were computed using utility scores obtained from the 12-item Short Form (SF-12) generic health scale. Other PROs included perceived symptoms, depression, anxiety, and stress. In the 96-week base-case analysis, we estimated the unadjusted and multivariate-adjusted (1) mean costs (in US$, 2016 values) and QALYs/patient, (2) incremental costs and QALYs/patient, and (3) net health benefit (NHB). Outcomes were extrapolated over 5 and 10 years. Uncertainty was assessed using the cost-effectiveness acceptability curve and scenario and cost-effective price threshold analyses. RESULTS: In the base-case analysis, the NHB (95% confidence interval) for the DTG-based regimen relative to the EFV400-based regimen was 0.056 (- 0.037 to 0.153), corresponding to an 88% probability of DTG being cost-effective. A 10% decrease in this regimen's price (from $5.2 to $4.7/month) would increase its cost-effectiveness probability to 95%. When extrapolating outcomes over 5 and 10 years, the DTG-based regimen had a 100% probability of being cost-effective for a large range of cost-effectiveness thresholds. CONCLUSIONS: At 2020 antiretroviral drug prices, a DTG-based first-line regimen should be preferred over an EFV400-based regimen in sub-Saharan Africa.
