Cost-Effectiveness of Newer Antiretroviral Drugs in Treatment-Experienced Patients With Multidrug-Resistant HIV Disease

Abstract

Objective Newer antiretroviral drugs provide substantial benefits but are expensive. We determined the cost-effectiveness of using antiretroviral drugs in combination for patients with multi-drug resistant HIV disease. Design We built a cohort state-transition model representing treatment-experienced patients with low CD4 counts, high viral load levels, and multi-drug resistant virus. We estimated the effectiveness of newer drugs (those approved in 2005 or later) from published randomized trials. We estimated other parameters from a randomized trial and from the literature. The model had a lifetime time horizon and used the perspective of an ideal insurer in the United States. The interventions were combination antiretroviral therapy, consisting of two newer drugs and one conventional drug, compared to three conventional drugs. Outcome measures were life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. Results Substituting newer antiretroviral drugs increased expected survival by 3.9 years in advanced HIV disease. The incremental cost-effectiveness ratio of newer, compared to conventional, antiretroviral drugs was $75,556/QALY gained. Sensitivity analyses showed that substituting only one newer antiretroviral drug cost $54,559 to $68,732/QALY, depending on assumptions about efficacy. Substituting three newer drugs cost $105,956 to $117,477/QALY. Cost-effectiveness ratios were higher if conventional drugs were not discontinued. Conclusions In treatment-experienced patients with advanced HIV disease, use of newer antiretroviral agents can be cost effective, given a cost-effectiveness threshold in the range of $50,000 to $75,000 per QALY gained. Newer antiretroviral agents should be used in carefully selected patients for whom less expensive options are clearly inferior.

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

“…These newer antiretroviral drugs are more effective in treatment of drug resistant HIV but, on the other hand, are also more expensive than those used previously, causing substantial incremental costs [5, 6]. …”

“…Due to the important decrease in mortality and consequent aging of HIV-infected people, HIV infection is responsible for an increasing burden on healthcare services. Treating with ART has resulted in a continuous increase of the total treatment cost, mainly because of the appearance of new, more effective but more expensive drugs during last years [5, 6]. The increase in life expectancy of HIV-infected patients [7, 8] has also driven increased costs due to life-long HIV treatment and concurrent age-related comorbidities [9].…”

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

“…For example, despite its high cost, the benefits of ART are so large it is considered cost-effective. 118–120 …”

The Potential Cost-Effectiveness of Pre-Exposure Prophylaxis Combined with HIV Vaccines in the United States

“…We developed a model based on previous works by Sanders et al and Bayoumi et al [30,31]. Importantly, we add functions to describe PrEP of varying duration and HIV vaccines with waning efficacy and boosting.…”