Abstract | OBJECTIVE: METHODS: A Markov model with a 3-month cycle time and six CD4 cell-count-based health states (>500, 351-500, 201-500, 101-200, 51-100, and 0-50 cells/mm(3)) followed a cohort of treatment-naive adults with HIV-1 infection through initial darunavir/r or lopinavir/r combination therapy and a common set of subsequent regimens over the course of their remaining lifetimes. Population characteristics and transition probabilities were estimated from the ARTEMIS clinical trial and other trials. Costs (in 2014 Canadian dollars), utilities, and mortality were estimated from Canadian sources and published literature. Costs and health outcomes were discounted at 5% per year. One-way and probabilistic sensitivity analyses were performed, including a simple indirect comparison of the darunavir/r initial regimen with an atazanavir/r-based regimen. RESULTS: In the base-case lifetime analysis, individuals receiving initial therapy with the darunavir/r regimen experienced 0.25 more quality-adjusted life-years (QALYs) with lower antiretroviral drug costs (-$14,246) and total costs (-$18,402) than individuals receiving the lopinavir/r regimen, indicating that darunavir/r dominated lopinavir/r. In an indirect comparison with an atazanavir/r-based regimen, the darunavir/r regimen remained the dominant choice, but with lower cost savings (-$2,303) and QALY gains (0.02). Results were robust to a wide range of other changes in input parameter values, population characteristics, and modeling assumptions. The probabilistic sensitivity analysis demonstrated that the darunavir/r regimen was cost effective compared with the lopinavir/r regimen in over 86% of simulations for willingness-to-pay thresholds between $0 and $100,000 per QALY gained. CONCLUSIONS:
Darunavir/ r 800/100 mg QD may be a cost-effective PI/r component of initial antiretroviral therapy for treatment-naive adults with HIV-1 infection in Canada.
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Authors | Anita J Brogan, Erik Smets, Josephine A Mauskopf, Sarah A L Manuel, Ines Adriaenssen |
Journal | PharmacoEconomics
(Pharmacoeconomics)
Vol. 32
Issue 9
Pg. 903-17
(Sep 2014)
ISSN: 1179-2027 [Electronic] New Zealand |
PMID | 24906477
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Drug Combinations
- Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination
- HIV Protease Inhibitors
- Lopinavir
- Ritonavir
- Darunavir
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Topics |
- Adult
- Antiretroviral Therapy, Highly Active
- CD4 Lymphocyte Count
- Canada
- Clinical Trials, Phase III as Topic
- Cost-Benefit Analysis
- Darunavir
(adverse effects, economics)
- Drug Combinations
- Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination
- HIV Infections
(drug therapy, economics)
- HIV Protease Inhibitors
(economics)
- HIV-1
- Humans
- Lopinavir
(adverse effects, economics)
- Markov Chains
- Ritonavir
(economics)
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