Cost Effectiveness of Darunavir/Ritonavir 600/100mg bid in Treatment-Experienced, Lopinavir-Naive, Protease Inhibitor-Resistant, HIV-Infected Adults in Belgium, Italy, Sweden and the UK

Abstract

From the perspective of Belgian, Italian, Swedish and UK payers, DRV/r 600/100 mg bid-based HAART is predicted to be cost effective compared with LPV/r 400/100 mg bid-based therapy, when used to manage treatment experienced, lopinavir-naive, PI-resistant, HIV-infected adults with a broad range of previous PI use/failure.

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

“…[32,33] These results are robust even when tested in extensive sensitivity and variability analyses. [12,13,25,26] The comprehensive approach to economic evaluation for DRV/r taken in this supplement reflects our understanding that in the current era healthcare funding -even for high-profile diseases such as HIV -is coming under increased pressure and lifetime costs of treating HIV are increasing. [3,[55][56][57] A highly diverse group of decision-makers are involved in discussions about antiretroviral drug pricing, reimbursement and market access, and therefore need to understand the economic impacts of a new antiretroviral drug to make sound decisions.…”

“…[34,35] Moreover, these ratios are robust, as demonstrated by both one-way sensitivity and variability analyses and multiway. [12,25,26] For example, the PSAs estimate that the probability of a cost-utility ratio for DRV/r compared with control PIs of less than US$50 000 (for the USA), less than d30 000 (for the UK) and less than h30 000 (for the three continental European countries) over a lifetime horizon is 95.0%, 93.5% and at least 94%, respectively. Table II presents the results of the economic analyses of DRV/r plus an OBR compared to LPV/r plus an OBR using efficacy data from the subset of participants in the TITAN trial who had at least one International AIDS Society USA primary PI RAM at baseline in the same countries.…”

“…Table II presents the results of the economic analyses of DRV/r plus an OBR compared to LPV/r plus an OBR using efficacy data from the subset of participants in the TITAN trial who had at least one International AIDS Society USA primary PI RAM at baseline in the same countries. [13,26] With the exception of the efficacy-related inputs, which were directly derived from this subpopulation of TITAN study participants, most input parameter values and model assumptions used in the POWER-based models were kept the same in this adaptation. Switching to the tipranavir boosted with ritonavir-based follow-up regimen was, however, assumed to occur sooner in PLHIV with a less than 1 log 10 decrease in the HIV-RNA level from baseline at 24 weeks and before the CD4 cell count begins to decline for all virological response groups.…”

“…Reflecting this, the PSAs generally estimated somewhat lower probabilities (75.4% for the USA and at least 67% for the European countries) of having a cost-utility ratio below US$50 000 or h30 000, respectively. [13,26] It should be noted that, in comparison with the PLHIV included in the POWER trials, the TITAN subpopulation modelled in this analysis had less advanced HIV disease and a more limited degree of previous treatment experience (only 60% of them were three-class experienced in contrast to the POWER participants, who were all three-class experienced at baseline). [19,21] More importantly, whereas all POWER participants had received (and failed) at least two PIcontaining HAART regimens before enrolment, more than 40% of the PI-resistant TITAN subgroup modelled in this analysis had only received up to one PI before enrolment in TITAN.…”

“…[12,13,[25][26][27] All the studies use as the basis for their costs and benefits estimates the efficacy results of the DRV/r clinical trials in treatmentexperienced individuals. Each study, however, estimates a different aspect of the economics of DRV/r including:…”