A Predictive Model of Health State Utilities for HIV Patients in the Modern Era of Highly Active Antiretroviral Therapy

Kauf, Teresa L.; Roskell, Neil; Shearer, Arran; Gazzard, Brian; Mauskopf, Josephine; Davis, Elizabeth B.; Nimsch, Christopher

doi:10.1111/j.1524-4733.2008.00326.x

Cited by 50 publications

(47 citation statements)

References 41 publications

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“…The utility weights for patients with HIV were calculated using a linear regression based on age, gender, race, IDU and CD4 count [42]. To these weights, were then applied the utility decrements related to the development of side effects [43][44][45][46][47][48][49][50] and HIV-related and -unrelated diseases [41,[51][52][53][54][55].…”

Section: Utilitymentioning

confidence: 99%

A cost-effectiveness analysis of E/C/F/TAF vs three boosted regimens in the Italian context

Pradelli¹,

Perri

Rizzardini

et al. 2017

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BACKGROUND: Highly Active Antiretroviral Therapy (HAART) has transformed HIV into a lifelong condition. Following the chronicity of the disease, and significant increase in lifespan -the prevalence of comorbidities increased in HIV+ subjects that are exposed both to a higher risk of developing cardiovascular disease, renal disease, osteopenia/osteoporosis and diabetes, and to the risk of developing them early. Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate (E/C/F/TAF), a complete, Single-Tablet antiretroviral Regimen (STR) that combines the effectiveness and tolerability of integrase inhibitors with an innovative backbone was recently introduced in Italy. Compared to Tenofovir Disoproxil Fumarate (TDF), TAF reaches the sites of action more efficiently, reducing tenofovir plasma concentration to more than 90% and the risk of off-target effects. OBJECTIVE: A patient-level micro-simulation model was adapted to the Italian context to evaluate E/C/F/TAF costeffectiveness vs three boosted regimens for HIV+ patients treatment. METHODS: A Markov micro-simulation model was adapted to the Italian context for the evaluation of the cost-effectiveness in patients with HIV. The total cost per patient accounts for drug therapies and the management of adverse events and comorbidities. The quality-adjusted life expectancy (in QALYs) is calculated by weighing the years of life lived by the utility weights. A 70-year time horizon was adopted to simulate a lifetime analysis; shorter time horizons were considered in the sensitivity analyses. 3.5% discount rate was applied both for costs and future benefits. The rate of virologic suppression at 48 weeks with E/C/F/TAF is 92.3%; for the other treatments such proportion is calculated by applying to the reference rate the relative risks, as calculated in a recent network meta-analysis (NMA). Alternative treatments considered in this analysis are three boosted regimens commonly used in Italy: tenofovir disoproxil fumarate/emtricitabine/elvitegravir/ cobicistat in STR; tenofovir disoproxil fumarate/emtricitabine + darunavir/ritonavir; tenofovir disoproxil fumarate/emtricitabine + atazanavir/ritonavir. RESULTS: E/C/F/TAF improves survival and quality of life (20.17 LY and 14.89 QALY), with the lowest total cost (€ 280,528), thus resulting dominant over three comparators considered as starting therapy. The sensitivity analysis confirms the results of the base case: at a willingness-to-pay threshold of € 30,000 per QALY, the E/C/F/TAF strategy is the most cost-effective, with a 90% probability and it is the most cost-effective even with a threshold of € 10,000 per QALY, with a 50% probability. CONCLUSION: E/C/F/TAF can be a sustainable alternative to currently available treatments, combining the advantage of the STR to lower risks of kidney and bone damage than observed in regimens based on TDF.

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Section: Utilitymentioning

confidence: 99%

A cost-effectiveness analysis of E/C/F/TAF vs three boosted regimens in the Italian context

Pradelli¹,

Perri

Rizzardini

et al. 2017

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“…In the study by Kauf et al [22], 1583 patients from five different trials in phase II, III, randomized IV and open- …”

Section: Utilities Parametersmentioning

confidence: 99%

“…In order to estimate quality-adjusted life-years (QALYs) lived by the two populations following the two analysis scenarios, the utilities reported in two studies already used in different national publications have been considered (Table 2) [21,22]. The utilities in our model have been distributed according to the modelling practice of economic evaluations, using beta distributions with minimum and maximum values of the two studies.…”

Section: Utilities Parametersmentioning

confidence: 99%

Early Treatment in HIV Patients: A Cost–Utility Analysis from the Italian Perspective

et al. 2016

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Our model represents a tool for policy makers and health-care professionals to provide information on the cost effectiveness of the early-treatment approach in HIV-infected patients in Italy. Starting HAART earlier keeps HIV-infected patients in better health and reduces the incidence of AIDS- and non-AIDS-related events, generating a gain in terms of both patients' health and correct resource allocation.

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“…We identified preference-based utility weights (Table 1) corresponding to health men in the general population and CD4 t-cell count categories of infected persons ( Figure 1) in published literature [30,[37][38][39][40]. Utilities for uninfected MSM are stratified by age and based on healthy males in the general US population [37].…”

Section: Health State Utilitymentioning

confidence: 99%

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Adamson¹,

Carlson²,

Kublin³

et al. 2017

Preprint

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This economic evaluation aims to support policy-making on the combined use of preexposure prophylaxis (PrEP) with HIV vaccines by evaluating the potential cost-effectiveness of implementation that would support the design of clinical trials for assessment of combined product safety and efficacy. The target study population is a cohort of men who have sex with men (MSM) in the United States. Policy strategies considered include standard HIV prevention, daily oral PrEP, HIV vaccine, and their combination. We constructed a Markov model based on clinical trial data and published literature. We used a payer perspective, monthly cycle length, a lifetime horizon, and a 3% discount rate. We assumed a price of $500 per HIV vaccine series in the base case. HIV vaccines dominated standard care and PrEP. At current prices,PrEP was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective (ICER=$463,448/QALY) as compared to vaccination alone. Sensitivity analyses suggest a combination may be valuable for higher-risk men with good adherence. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness. Results suggest that boosting potential may be key to HIV vaccine value.

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A Predictive Model of Health State Utilities for HIV Patients in the Modern Era of Highly Active Antiretroviral Therapy

Abstract: HIV patients' health-related quality of life may be substantially affected by clinically relevant patient-, disease-, and treatment-related factors, such as injection drug use, disease status, food/drink restrictions, and AEs.

Cited by 50 publications

References 41 publications

A cost-effectiveness analysis of E/C/F/TAF vs three boosted regimens in the Italian context

A cost-effectiveness analysis of E/C/F/TAF vs three boosted regimens in the Italian context

Early Treatment in HIV Patients: A Cost–Utility Analysis from the Italian Perspective

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

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