estimated cost and effectiveness for four treatment strategies: 1) Standard dual therapy pegylated interferon alfa and ribavirin (PR); 2) BOCϩPR triple therapy; 3) TELϩPR triple therapy; and 4) no treatment. RESULTS: In our model, patients received 1) PR for 48 weeks; 2) TEL for 12 weeks with PR for 34-36 weeks; or 3) BOC for 29 weeks with PR for 34-36 weeks. Estimated treatment cost associated with PR alone, BOCϩPR, and TELϩPR are about $8,300, $31,000 and $45,000 per average patient, respectively. Total system-wide costs to adopt BOCϩPR or TELϩPR would be $673 million and $971 million, respectively. Assuming continuation of the current 21% VHA treatment rates and optimal SVR results, the long term reduction in liver related death from treatment PR, BocϩPR, and TelϩPR are 7.9%, 13.1%, and 14.5%, respectively. CONCLUSIONS: Our model indicates upfront investments with BOCϩPR, and TELϩPR are high, with the benefits of extending quality of life and lower costs due to liver-related morbidity. Though model projected potential cost under these assumptions, a clinical trial of comparative effectiveness would be needed to evaluate both costs and benefits of DAAs in veterans. OBJECTIVES:In Brazil, switching to a protease inhibitor (PI) based ARV regimen is recommended as second line therapy for experienced patients failing non-nucleoside reverse transcriptase inhibitors. The BMS-045 study compared ATVϩRTV and LPV/r regimens in ARV-experienced patients. Similar viral load (VL) suppression rates Ͻ400 copies were reported, but LPV/r provided greater suppression rate Ͻ50 copies. Total cholesterol (TC) levels improved to guideline levels in 23% of ATVϩRTV patients and became elevated in 7% of LPV/r patients at 48 weeks. The long term clinical and cost impact of this difference is not yet clear. The objective of this study was to examine the long term HRQL and economic implications in Brazil for LPV/r versus ATVϩRTV treatment of ARV-experienced patients. METHODS: A previously published HIV Markov model was adapted. Baseline assumptions: TC profile and CD4 cell distribution matching the BMS-045 population. HRQL and survival outcomes were measured in quality adjusted life years (QALYs). Costs in Brazilian Reale were indexed to 2011. ARV costs and HIV treatment patterns were based on Brazilian references. Lifetime costs/outcomes were discounted at 3% per annum. A national health services perspective was adopted. RESULTS: VL suppression differences favored LPV/r, driving a net improvement in survival (0.31 QALYs, 106 days). Five and 10 year cost savings (BRL1,816, BRL1,496 per patient) were projected for LPV/r. Lifetime costs were slightly higher for LPV/r due to improved survival. An incremental cost effectiveness ratio (ICER) of BRL2319 per QALY gained was estimated for the LPV/r regimen, which is highly acceptable by Brazilian threshold . CONCLUSIONS: Compared to ATVϩRTV, an LPV/r based regimen is cost saving through the first 10 years of survival and is a cost effective use of public resources for ARV-experienced Brazilian pati...