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This study evaluates the budgetary impact of adding ibalizumab, a recently approved, long-acting post-attachment HIV-1 inhibitor to a United States (US) Medicare health plan for the treatment of multidrug-resistant (MDR) HIV-1 infection. Methods: A budget-impact model with an underlying Markov structure was developed to estimate the economic impact of including ibalizumab on a hypothetical Medicare plan with 1 million members. The model compares costs over a 3-year period for two scenarios: with and without ibalizumab included on the formulary as an add-on to optimized background therapy. Model inputs were based on ibalizumab clinical trial data, market uptake projections (5%, 10%, 15%), and published literature, with costs in 2019 US dollars. The model estimates the number of treatment-eligible beneficiaries with MDR HIV-1 infection, total annual and per-member per-month (PMPM) costs for each scenario, and the incremental budget impact. Key input parameters were tested in scenario analyses. Results: In year 1, approximately 62.6 Medicare beneficiaries with MDR HIV-1 are expected to be treated with antiretroviral therapy.

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