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Cost-effectiveness of nucleoside reverse transcriptase inhibitor pairs in efavirenz-based regimens for treatment-naïve adults with HIV infection in the United States.
Value Health. 2011 Jul-Aug; 14(5):657-64.VH

Abstract

OBJECTIVE

To estimate the cost-effectiveness of once-daily tenofovir/emtricitabine compared with twice-daily zidovudine/lamivudine and once-daily abacavir/lamivudine in treatment-naïve adults with HIV-1 infection in the United States.

METHODS

A Markov model with four therapy lines and six health states based on CD4(+) cell-count ranges was developed to estimate lifetime costs and health outcomes. Efficacy data (virologic response and CD4(+) cell-count changes) for first-line therapy were from 144-week results of Study 934 comparing tenofovir/emtricitabine with zidovudine/lamivudine and 48-week results of Study CNA30024 comparing abacavir/lamivudine with zidovudine/lamivudine, all in combination with efavirenz. Data from Study CNA30024 for abacavir/lamivudine were adjusted to allow for an indirect comparison with tenofovir/emtricitabine. Subsequent therapy lines were based on likely baskets of antiretroviral therapy recommended by US treatment guidelines. Utility values, mortality rates, and costs (2009 US dollars) were obtained from published sources. Base-case results were tested in sensitivity and variability analyses.

RESULTS

Average discounted results showed that individuals using tenofovir/emtricitabine were predicted to remain on first-line therapy for 7.7 years, accrue lifetime costs of $747,327, and experience 15.75 quality-adjusted life-years (QALYs), compared with 6.0 years, $777,090, and 15.68 QALYs for individuals using abacavir/lamivudine and 5.8 years, $778,287, and 15.44 QALYs for individuals using zidovudine/lamivudine. Tenofovir/emtricitabine was cost-effective compared with the other two first-line regimens in more than 75% of all probabilistic sensitivity analysis simulation runs for every willingness-to-pay threshold between $0 and $250,000 per QALY gained. Results were robust in variability and one-way sensitivity analyses.

CONCLUSIONS

Tenofovir/emtricitabine was predicted to be more effective and cost-saving compared with abacavir/lamivudine and zidovudine/lamivudine in treatment-naïve adults with HIV-1 infection in the United States.

Authors+Show Affiliations

RTI Health Solutions, Research Triangle Park, NC 27709, USA. abrogan@rti.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21839403

Citation

Brogan, Anita J., et al. "Cost-effectiveness of Nucleoside Reverse Transcriptase Inhibitor Pairs in Efavirenz-based Regimens for Treatment-naïve Adults With HIV Infection in the United States." Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research, vol. 14, no. 5, 2011, pp. 657-64.
Brogan AJ, Talbird SE, Cohen C. Cost-effectiveness of nucleoside reverse transcriptase inhibitor pairs in efavirenz-based regimens for treatment-naïve adults with HIV infection in the United States. Value Health. 2011;14(5):657-64.
Brogan, A. J., Talbird, S. E., & Cohen, C. (2011). Cost-effectiveness of nucleoside reverse transcriptase inhibitor pairs in efavirenz-based regimens for treatment-naïve adults with HIV infection in the United States. Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research, 14(5), 657-64. https://doi.org/10.1016/j.jval.2011.01.009
Brogan AJ, Talbird SE, Cohen C. Cost-effectiveness of Nucleoside Reverse Transcriptase Inhibitor Pairs in Efavirenz-based Regimens for Treatment-naïve Adults With HIV Infection in the United States. Value Health. 2011 Jul-Aug;14(5):657-64. PubMed PMID: 21839403.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of nucleoside reverse transcriptase inhibitor pairs in efavirenz-based regimens for treatment-naïve adults with HIV infection in the United States. AU - Brogan,Anita J, AU - Talbird,Sandra E, AU - Cohen,Calvin, Y1 - 2011/06/12/ PY - 2010/08/25/received PY - 2010/12/17/revised PY - 2011/01/29/accepted PY - 2011/8/16/entrez PY - 2011/8/16/pubmed PY - 2011/10/8/medline SP - 657 EP - 64 JF - Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research JO - Value Health VL - 14 IS - 5 N2 - OBJECTIVE: To estimate the cost-effectiveness of once-daily tenofovir/emtricitabine compared with twice-daily zidovudine/lamivudine and once-daily abacavir/lamivudine in treatment-naïve adults with HIV-1 infection in the United States. METHODS: A Markov model with four therapy lines and six health states based on CD4(+) cell-count ranges was developed to estimate lifetime costs and health outcomes. Efficacy data (virologic response and CD4(+) cell-count changes) for first-line therapy were from 144-week results of Study 934 comparing tenofovir/emtricitabine with zidovudine/lamivudine and 48-week results of Study CNA30024 comparing abacavir/lamivudine with zidovudine/lamivudine, all in combination with efavirenz. Data from Study CNA30024 for abacavir/lamivudine were adjusted to allow for an indirect comparison with tenofovir/emtricitabine. Subsequent therapy lines were based on likely baskets of antiretroviral therapy recommended by US treatment guidelines. Utility values, mortality rates, and costs (2009 US dollars) were obtained from published sources. Base-case results were tested in sensitivity and variability analyses. RESULTS: Average discounted results showed that individuals using tenofovir/emtricitabine were predicted to remain on first-line therapy for 7.7 years, accrue lifetime costs of $747,327, and experience 15.75 quality-adjusted life-years (QALYs), compared with 6.0 years, $777,090, and 15.68 QALYs for individuals using abacavir/lamivudine and 5.8 years, $778,287, and 15.44 QALYs for individuals using zidovudine/lamivudine. Tenofovir/emtricitabine was cost-effective compared with the other two first-line regimens in more than 75% of all probabilistic sensitivity analysis simulation runs for every willingness-to-pay threshold between $0 and $250,000 per QALY gained. Results were robust in variability and one-way sensitivity analyses. CONCLUSIONS: Tenofovir/emtricitabine was predicted to be more effective and cost-saving compared with abacavir/lamivudine and zidovudine/lamivudine in treatment-naïve adults with HIV-1 infection in the United States. SN - 1524-4733 UR - https://www.unboundmedicine.com/medline/citation/21839403/Cost_effectiveness_of_nucleoside_reverse_transcriptase_inhibitor_pairs_in_efavirenz_based_regimens_for_treatment_naïve_adults_with_HIV_infection_in_the_United_States_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1098-3015(11)00138-0 DB - PRIME DP - Unbound Medicine ER -