Cost-effectiveness of three alternative boosted protease inhibitor-based second-line regimens in HIV-infected patients in West and Central Africa
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1 mars 2020
info:eu-repo/semantics/openAccess , http://creativecommons.org/licenses/by-nc/
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AIDS COST-BENEFIT_ANALYSIS THERAPY CENTRAL_AFRICA WESTERN_AFRICA BURKINA_FASO CAMEROON SENEGALSujets proches
Upper limb Limb, Upper Upper extremities Extremity, Upper Pectoral limbs Limb, Pectoral Thoracic limbs Extremities, Upper Upper limbs Limb, Thoracic Arms (Anatomy) Thoracic limb Upper extremity Pectoral limbCiter ce document
Sylvie Boyer et al., « Cost-effectiveness of three alternative boosted protease inhibitor-based second-line regimens in HIV-infected patients in West and Central Africa », Archined : l'archive ouverte de l'INED, ID : 10.1007/s41669-019-0157-9
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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.
