Comparison of Markov Model and Dynamic Model in Economic Evaluations for Infectious Diseases: A case of Bictegravir/emtricitabine/tenofovir Treatment-native adults of HIV-1 in China

Abstract

Background: This study aimed to compare the performances between Markov model and dynamic model in economic evaluations for antiretroviral therapy (ART) of HIV, using a case of bictegravir/emtricitabine/tenofovir (B/F/TAF) for treatment-native adults of HIV-1 infection in China. Methods: A Markov model was used to simulate in detail the lifetime treatment of HIV among adult patients with ART with a cycle of one month. A dynamic model was used to consider the effects of ART on preventing transmission among all Chinese adults, with a time frame of 30 years and a cycleof one year. The primary outcomes were total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were conducted for result validation, and the model precision was tested using relative standard deviation (RSD). Results: In Markov model and dynamic model, compared with dolutegravir/lamivudine (DTG/3TC), B/F/TAF incurred higher per-person expenses ($44,381.33 and $30.94 versus $42,160.13 and $29.28) but yielded superior QALYs (12.7788 and 17.9423 vs 12.6310 and 17.9420), resulting in higher ICER for Markov model compared to dynamic model (14,081.23 vs 6,524.03 USD/QALY). The robustness of the results was confirmed in uncertainty analyses, and Markov model exhibited a lower RSD. Conclusion: B/F/TAF is deemed cost-effective in China according to both models, presenting a valuable treatment option despite its higher price in the era of optimized HIV care. The choice of the economic evaluation model influences the ICERs of ART, with dynamic model advantageous for incorporating externality and Markov model noted for its precision.