Cost Effectiveness of Darunavir/Ritonavir 600/100mg bid in Protease Inhibitor-Experienced, HIV-1-Infected Adults in Belgium, Italy, Sweden and the UK

Moeremans, K; Annemans, Lieven; Löthgren, Mickael; Allegri, G.; Wyffels, Veronique; Hemmet, Lindsay; Caekelbergh, K; Smets, Erik

doi:10.2165/11587480-000000000-00000

Cited by 18 publications

(23 citation statements)

References 61 publications

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“…The costs of salvage regimens are high, however, there is data from high-income countries showing that DRV/r with an OBT is cost effective compared with control protease inhibitors (PIs) in highly treatment-experienced patients. 7,8 DRV/r is available in Brazil and other middle-income countries, however, there is no published studies about its efficacy in this setting.…”

Section: Introductionmentioning

confidence: 99%

High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil

Vidal

Song

Matos

et al. 2013

The Brazilian Journal of Infectious Diseases

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Section: Introductionmentioning

confidence: 99%

High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil

Vidal

Song

Matos

et al. 2013

The Brazilian Journal of Infectious Diseases

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“…[25] These countries included Canada, the UK, Sweden, Italy and Belgium. To perform each country-specific adaptation the following steps were taken.…”

Section: Economic Evaluation For Darunavirmentioning

confidence: 99%

“…Incremental cost-utility of DRV/r plus OBR compared with lopinavir boosted with ritonavir (LPV/r) plus OBR in treatment-experienced PLHIV with a broader degree of previous PI exposure/failure, using data from the subset of participants in the TITAN trial who had at least one International AIDS Society USA primary PI resistance-associated mutation (RAM) at baseline. The results of the analysis of DRV/r compared with an investigator-selected control PI regimen using the pooled efficacy data from the POWER 1 and 2 trials for the USA [12] and the four European countries [25] over a lifetime horizon are presented in table I.…”

Section: Economic Evaluation For Darunavirmentioning

confidence: 99%

“…[34,35] Moreover, these ratios are robust, as demonstrated by both one-way sensitivity and variability analyses and multiway. [12,25,26] For example, the PSAs estimate that the probability of a cost-utility ratio for DRV/r compared with control PIs of less than US$50 000 (for the USA), less than d30 000 (for the UK) and less than h30 000 (for the three continental European countries) over a lifetime horizon is 95.0%, 93.5% and at least 94%, respectively. Table II presents the results of the economic analyses of DRV/r plus an OBR compared to LPV/r plus an OBR using efficacy data from the subset of participants in the TITAN trial who had at least one International AIDS Society USA primary PI RAM at baseline in the same countries.…”

Section: Economic Evaluation For Darunavirmentioning

confidence: 99%

“…[12,13,[25][26][27] All the studies use as the basis for their costs and benefits estimates the efficacy results of the DRV/r clinical trials in treatmentexperienced individuals. Each study, however, estimates a different aspect of the economics of DRV/r including:…”

Section: Introductionmentioning

confidence: 99%

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A Review of Economic Evaluations of Darunavir Boosted by Low-Dose Ritonavir in Treatment-Experienced Persons Living with HIV Infection

et al. 2010

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Darunavir boosted by low-dose ritonavir (DRV/r), at a daily dose of 600/100 mg twice a day (bid), has been shown to be superior to alternative highly active antiretroviral therapy (HAART) regimens for the management of treatment-experienced, HIV-infected adults in the phase IIb POWER trials and the phase III TITAN trial. Economic analyses of different types that have been performed for several countries to investigate the cost effectiveness and budgetary impact of DRV/r 600/100 mg bid for treatment-experienced people living with HIV (PLHIV) based on the clinical data gathered in the POWER and TITAN trials are reviewed for consistency and their value to different decision-makers is assessed. Cost-utility analyses for the USA and several European countries indicate that DRV/r-based HAART is cost effective compared with other standard of care protease inhibitor (PI)-based regimens in PLHIV with evidence of PI resistance. For all of these countries, the estimated cost-utility ratio is well below typical benchmark values and these ratios are robust, as demonstrated by one-way sensitivity and variability analyses and multi-way probabilistic sensitivity analyses. Studies using other metrics including the average 1-year drug cost per patient with a plasma HIV-RNA level less than 50 copies/mL at 48 weeks, the incremental drug cost per additional patient with a plasma HIV-RNA level less than 50 copies/mL at 48 weeks, the total (antiretroviral and non-antiretroviral) costs during the first year of treatment, and the total healthcare budget impact during the first 5 years of treatment provided further evidence of the positive economic outcomes with the use of DRV/r in treatment-experienced PLHIV. Different measures of economic outcomes are useful for different types of decision-makers and different types of decisions. In general, the results of these different types of analyses will be consistent with each other. For darunavir, the economic analyses reviewed in this paper demonstrate that the use of DRV/r 600/100 mg bid in the management of HIV-infected, treatment-experienced adults who have failed at least one of the other currently available PIs is cost effective and may be cost saving.

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Darunavir: A Review of Its Use in the Management of HIV-1 Infection

Deeks

2013

Drugs

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The latest HIV-1 protease inhibitor (PI) darunavir (Prezista™) has a high genetic barrier to resistance development and is active against wild-type HIV and HIV strains no longer susceptible to some older PIs. Ritonavir-boosted darunavir, as a component of antiretroviral therapy (ART), is indicated for the treatment of HIV-1 infection in adult and paediatric patients (aged ≥3 years), with or without treatment experience (details vary depending on region of approval). Several open-label or partially-blinded trials have evaluated the efficacy of ritonavir-boosted darunavir ART regimens for up to 192 weeks in these settings. In treatment-naïve adults, once-daily boosted darunavir was no less effective in establishing virological suppression than once- or twice-daily boosted lopinavir, yet was more effective at maintaining suppression long term. Moreover, treatment-experienced adults with no darunavir resistance-associated mutations (RAMs) had no less effective viral load suppression with once-daily than with twice-daily boosted darunavir. In treatment-experienced adults, including some with multiple major PI RAMs, twice-daily boosted darunavir was more effective than twice-daily boosted lopinavir or boosted control PIs in reducing viral load, and provided virological benefit as part of a salvage regimen in those with few remaining treatment options. Boosted darunavir also reduced viral load when administered once-daily in treatment-naïve adolescents or twice-daily in treatment-experienced children and adolescents. Boosted darunavir is generally well tolerated, with gastrointestinal disturbances and lipid abnormalities among the most common tolerability issues. It has a lipid profile more favourable than that of boosted lopinavir in terms of total cholesterol and triglyceride changes and, when administered once daily, its lipid effects are generally similar to those of boosted atazanavir. Thus, boosted darunavir is a useful option for the ART regimens of adult and paediatric patients with HIV-1 infection.

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Cost Effectiveness of Darunavir/Ritonavir 600/100mg bid in Protease Inhibitor-Experienced, HIV-1-Infected Adults in Belgium, Italy, Sweden and the UK

Cited by 18 publications

References 61 publications

High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil

High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil

A Review of Economic Evaluations of Darunavir Boosted by Low-Dose Ritonavir in Treatment-Experienced Persons Living with HIV Infection

Darunavir: A Review of Its Use in the Management of HIV-1 Infection

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