Economic modeling of the combined effects of HIV disease, heart disease and lipoatrophy based on ACTG 5142 trial data

Abstract

Antiretroviral (ARV) regimens may be statistically noninferior in clinical trials, but have very different economic outcomes due to differences in costs and adverse event profiles. Given the heavy cost burden of HIV disease, it is important to consider economic issues when selecting an ARV regimen. This study examines the cost and consequences of initiating an ARV regimen including LPV/r or EFV, using data from a recent clinical trial in a previously published model of HIV-disease.

Economic modeling of HIV treatments

“…To accomplish this we may have to use a discrete event structure instead of a Markov approach. Whereas such a change is possible [46], it may require that organizations, such as the National Institute for Health and Clinical Excellence in the United Kingdom (NICE), Pharmaceutical Benefits Advisory Committee of Australia (PBAC), the Scottish Medicines Consortium (SMC) and other regulatory agencies, change their policies to accept this type of model for economic evaluations.…”

“…In a recent modeling study based on the ACTG 5142 data we found an unbalanced randomization in favor of lopinavir/r that affected the baseline distribution of patients among the combined viral load and CD4 cell countdefined health states. When we controlled for this bias by stratified random sampling of observations within each baseline strata, the incremental cost-effectiveness ratio (ICER) for lopinavir/r worsened by 32% [46].…”