A Review of Economic Evaluations of Darunavir Boosted by Low-Dose Ritonavir in Treatment-Experienced Persons Living with HIV Infection

Abstract

Darunavir boosted by low-dose ritonavir (DRV/r), at a daily dose of 600/100 mg twice a day (bid), has been shown to be superior to alternative highly active antiretroviral therapy (HAART) regimens for the management of treatment-experienced, HIV-infected adults in the phase IIb POWER trials and the phase III TITAN trial. Economic analyses of different types that have been performed for several countries to investigate the cost effectiveness and budgetary impact of DRV/r 600/100 mg bid for treatment-experienced people living with HIV (PLHIV) based on the clinical data gathered in the POWER and TITAN trials are reviewed for consistency and their value to different decision-makers is assessed. Cost-utility analyses for the USA and several European countries indicate that DRV/r-based HAART is cost effective compared with other standard of care protease inhibitor (PI)-based regimens in PLHIV with evidence of PI resistance. For all of these countries, the estimated cost-utility ratio is well below typical benchmark values and these ratios are robust, as demonstrated by one-way sensitivity and variability analyses and multi-way probabilistic sensitivity analyses. Studies using other metrics including the average 1-year drug cost per patient with a plasma HIV-RNA level less than 50 copies/mL at 48 weeks, the incremental drug cost per additional patient with a plasma HIV-RNA level less than 50 copies/mL at 48 weeks, the total (antiretroviral and non-antiretroviral) costs during the first year of treatment, and the total healthcare budget impact during the first 5 years of treatment provided further evidence of the positive economic outcomes with the use of DRV/r in treatment-experienced PLHIV. Different measures of economic outcomes are useful for different types of decision-makers and different types of decisions. In general, the results of these different types of analyses will be consistent with each other. For darunavir, the economic analyses reviewed in this paper demonstrate that the use of DRV/r 600/100 mg bid in the management of HIV-infected, treatment-experienced adults who have failed at least one of the other currently available PIs is cost effective and may be cost saving.

Virologic and Immunologic Effectiveness at 48 Weeks of Darunavir–Ritonavir-Based Regimens in Treatment-Experienced Persons Living with HIV-1 Infection in Clinical Practice

“…Darunavir/r was approved for clinical use by the Food and Drug Administration in June 2006. International studies have shown that DRV/r-based ART improves life expectancy and reduces the rate of disease progression compared with currently available PI-based therapy, leading to higher quality-adjusted life expectancy and cost savings in non-ARV-related cost categories. [18][19][20][21] In Brazil, it has been available for salvage therapy of treatment-experienced patients since 2008, based on efficacy data from clinical trials conducted in developed countries. The current study is the first Brazilian multicenter cohort to evaluate the effectiveness of DRV/r-based regimen for salvage therapy in diverse clinical settings.…”

Economic evaluation studies in the field of HIV/AIDS: bibliometric analysis on research development and scopes (GAPRESEARCH)

“…A key benefit of the utility-based units CUA uses is that they consider both the patients’ quality of life/health and the effects of interventions on mortality, which are more important than purely clinical outcomes often used in CEA. However, in practice, many studies in the field of HIV/AIDS reported both clinical outcomes and QALYs/DALYs outcomes; and they used the term “cost-effectiveness analysis” instead of “cost-utility analysis” [7, 8, 17, 24–26]. In CBA it is necessary to quantify the monetary value of the outcomes of healthcare interventions.…”

“…Ramos et al indicated that scientific production on HIV was dominated by the United States of America (USA) and Western Europe (accounted for 83% of total publications in 2003), while little empirical evidence was available in the most severe HIV-affected regions such as Sub-Sahara Africa or South East Asia [23]. This finding was also confirmed by other narrative and systematic reviews on economic evaluation in HIV/AIDS [7, 8, 17, 24–26]. A prior analysis in some low- and middle-income countries (LMICs) found that human capacity was a major limiting attributed to the unmet need of health economic evidence for decision-making process [27].…”

Cost-Effectiveness of Antiretroviral Therapy for Multidrug-Resistant HIV: Past, Present, and Future

“…Subjects in the comparator arms received single (74%) or dual (23%) boosted PIs (mainly lopinavir, saquinavir, and/or amprenavir/fosamprenavir) in POWER and lopinavir/r in TITAN. A recent systematic review summarized the results of a number of cost-utility analyses conducted alongside these trials and demonstrated that the use of darunavir/r in this setting was cost-effective and, in some cases, cost saving [ 44 ].…”