Cost-effectiveness of the long-acting regimen cabotegravir plus rilpivirine for the treatment of HIV-1 and its potential impact on adherence and viral transmission: A modelling study

Abstract

Introduction Combination antiretroviral therapy (cART) improves outcomes for people living with HIV (PLWH) but requires adherence to daily dosing. Suboptimal adherence results in reduced treatment effectiveness, increased costs, and greater risk of resistance and onwards transmission. Treatment with long-acting (LA), injection-based ART administered by healthcare professionals (directly observed therapy (DOT)) eliminates the need for adherence to daily dosing and may improve clinical outcomes. This study reports the cost-effectiveness of the cabotegravir plus rilpivirine LA regimen (CAB+RPV LA) and models the potential impact of LA DOT therapies. Methods Parameterisation was performed using pooled data from recent CAB+RPV LA Phase III trials. The analysis was conducted using a cohort-level hybrid decision-tree and state-transition model, with states defined by viral load and CD4 cell count. The efficacy of oral cART was adjusted to reflect adherence to daily regimens from published data. A Canadian health service perspective was adopted. Results CAB+RPV LA is predicted to be the dominant intervention when compared to oral cART, generating, per 1,000 patients treated, lifetime cost-savings of $1.5 million, QALY and life-year gains of 107 and 138 respectively with three new HIV cases averted. Conclusions Economic evaluations of LA DOTs need to account for the impact of adherence and HIV transmission. This study adds to the existing literature by incorporating transmission and using clinical data from the first LA DOT regimen. Providing PLWH and healthcare providers with novel modes of ART administration, enhancing individualisation of treatment, may facilitate the achievement of UNAIDS 95-95-95 objectives.

Clinical implementation of long-acting antiretroviral treatment in high-income countries: challenges and advantages

“…A modelling study from Canada concluded that, based on better adherence driving higher rates of viral suppression and fewer onward transmissions, IM-CAB/RPV would yield cost-savings ($1.5 million lifetime savings per 1000 patients treated), life-year and quality adjusted life-year gains and 3 fewer transmissions than oral ART [15]. However, predicted adherence to IM-CAB/RPV was based on that observed in clinical trials, whereas adherence to oral ART was based on real-life Canadian cohorts, assumptions that may favour the IM-ART strategy.…”

Long-Acting Injectable Therapy for People with HIV: Looking Ahead with Lessons from Psychiatry and Addiction Medicine

“…The cost of LAI ART and several first-line oral HIV medications is comparable [ 28 ]. According to the U.S. Department of Health and Human Services, the monthly average wholesale price of LAI cabotegravir/rilpivirine ranges from $4752 to $7218 depending on the dose, which amounts to $43,308 per year for bi-monthly injections or $57,024 per year for monthly injections (excluding oral lead-in and initiation injections).…”

“…Thus, as patents for oral HIV medications continue to expire, the cost differential between LAIs and oral medications will grow. Still, LAIs may remain cost-effective given greater beneficial impacts on adherence and viral suppression [28]. Because youth experience particular challenges adhering to ART for both treatment and prevention [31][32][33], cost analyses should estimate relative cost and benefits specific to young PWH.…”

Cabotegravir and Rilpivirine Long-Acting Antiretroviral Therapy Administered Every 2 Months is Cost-Effective for the Treatment of HIV-1 in Spain

“…A recent study in a sub-Saharan setting showed that CAB+RPV LA Q1M would be more cost-effective in PLHIV with suboptimal adherence; these results were also supported by a study in a US setting [ 18 , 19 ]. Additionally, a Canadian study demonstrated CAB+RPV LA Q1M to be the dominant intervention (more effective and less costly) compared with daily oral regimens [ 20 ]. Here, the cost-effectiveness of CAB+RPV LA Q2M compared with daily oral STRs was evaluated from the Spanish National Health System perspective.…”