Comparative cost-efficacy analysis of darunavir/ritonavir and other ritonavir-boosted protease inhibitors for first-line treatment of HIV-1 infection in the United States.

Abstract

PURPOSE:

A comprehensive study comparing the costs and efficacies of darunavir/ritonavir 800/100 mg qd and the other ritonavir-boosted (/r) protease inhibitors (PIs) recommended for treatment-naïve individuals with HIV-1 infection would help health care decision makers identify the value of each boosted PI.

METHODS:

A cost-efficacy model was developed to compare the five recommended boosted PIs, each used with a tenofovir-based nucleotide/nucleoside reverse transcriptase inhibitor backbone. Efficacy was measured by virologic response (ie, HIV-1 ribonucleic acid < 50 copies/mL) at 48 weeks, based on a systematic review and meta-analysis of recent clinical trials. One-year antiretroviral therapy costs and 48-week efficacy values were used to generate the efficiency frontier and cost-efficacy ratios.

RESULTS:

Darunavir/r was the most efficacious boosted PI, with an incremental cost-efficacy ratio of $27,390 per additional individual with virologic response, compared with fosamprenavir/r. All other regimens were dominated. Darunavir/r combination therapy also had one of the lowest average costs ($26,287) per individual with virologic response, resulting in a maximal number of individuals successfully treated within a fixed budget. The model results were robust in variability and sensitivity analyses.

CONCLUSION:

Darunavir/r 800/100 mg qd combination therapy represents a cost-efficacious option for treatment-naïve individuals with HIV-1 infection in the United States.

• Authors: Anita J Brogan, Joseph Mrus, Andrew Hill, Anthony W Sawyer, Erik Smets
• Journal: HIV clinical trials (HIV Clin Trials) 2010 May-Jun Vol. 11 Issue 3 Pg. 133-44 ISSN: 1528-4336 [Print] England
• PMID: 20736150 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• HIV Protease Inhibitors
• RNA, Viral
• Sulfonamides
• Ritonavir
• Darunavir

Topics

• Adult
• Antiretroviral Therapy, Highly Active
• Cost-Benefit Analysis
• Darunavir
• Endpoint Determination
• Female
• HIV Infections (drug therapy, economics, virology)
• HIV Protease Inhibitors (economics, therapeutic use)
• HIV-1
• Humans
• Male
• Models, Econometric
• RNA, Viral (blood)
• Ritonavir (economics, therapeutic use)
• Sulfonamides (economics, therapeutic use)
• Treatment Outcome
• United States