Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain
Objective: Fixed-dose combinations of antiretroviral drugs have meant an important step forward in simplifying treatment and improving compliance and has led to an increased effectiveness of therapy, a viral load decrease and improving the quality of life of patients. The single-table formulation of...
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| Format: | Article |
| Language: | English |
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Elsevier
2017-09-01
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| Series: | Farmacia Hospitalaria |
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| Online Access: | http://www.aulamedica.es/fh/pdf/10808.pdf |
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| author | Santiago Moreno Guillen Juan Emilio Losa García Juan Berenguer Berenguer José Manuel Martínez Sesmero Santiago Cenoz Gomis Ruth Graefenhain David Lopez Sanchez-Cambronero Francisco Javier Parrondo Garcia |
| author_facet | Santiago Moreno Guillen Juan Emilio Losa García Juan Berenguer Berenguer José Manuel Martínez Sesmero Santiago Cenoz Gomis Ruth Graefenhain David Lopez Sanchez-Cambronero Francisco Javier Parrondo Garcia |
| author_sort | Santiago Moreno Guillen |
| collection | DOAJ |
| description | Objective: Fixed-dose combinations of antiretroviral drugs have meant an important step forward in simplifying treatment and improving compliance and has led to an increased effectiveness of therapy, a viral load decrease and improving the quality of life of patients. The single-table formulation of dolutegravir with abacavir and lamivudine (DTG/ABC/3TC) is a highly efficacious and well-tolerated once-daily regimen for HIV-infected patients. The objective of the study was to assess the incremental cost-utility ratio of the fixed-dose combination of (DTG/ABC/3TC) versus the combinations emtricitabine/tenofovir/efavirenz (FTC/TDF/EFV), and darunavir/r (DRV/r) or raltegravir (RAL) with emtricitabine/tenofovir (FTC/TDF) or abacavir/lamivudine (ABC/3TC) as initial antiretroviral therapy in patients infected with HIV-1 from the perspective of the Spanish National Health System.
Method: The ARAMIS model, which uses a microsimulation approach to simulate the individual changes in each patient from the start of treatment to death through a Markov chain of descriptive health states of the disease, was adapted to Spain. The alternatives used for comparison were the fixed-dose combination of emtricitabine/tenofovir/efavirenz (FTC/TDF/EFV), and the fixed- dose combinations of emtricitabine/tenofovir (FTC/TDF) or abacavir/lamivudine (ABC/3TC) with darunavir/r (DRV/r) or raltegravir (RAL). The probability of achieving virological suppression by the treatments included in the model was obtained from clinical trials SINGLE, SPRING-2 and FLAMINGO and the costs were expressed in € (2015). The model use the perspective of the Spanish National Health System, with a lifetime horizon and a discount rate of 3% was applied to cost and effectiveness.
Results: Treatment initiation with DTG/ABC/3TC was dominant when it was compared with treatment initiation with all the comparators: vs. FTC/TDF/EFV (-67 210.71€/QALY), vs. DRV/r + FTC/TDF or ABC/3TC (-1 787 341.44€/QALY), and vs. RAL + FTC/TDF or ABC/3TC (-1 005 117.13€/QALY). All the sensitivity analyses performed showed the consistency of these findings.
Conclusions: With the premises considered, treatment initiation with DTG/ABC/3TC STR appears to be the most cost-effective option in ARTnaïve HIV infected patients from the Spanish Health System perspective |
| format | Article |
| id | doaj-art-7ede7df9bd0f45d3912e8aba657679b1 |
| institution | Kabale University |
| issn | 1130-6343 2171-8695 |
| language | English |
| publishDate | 2017-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Farmacia Hospitalaria |
| spelling | doaj-art-7ede7df9bd0f45d3912e8aba657679b12025-01-02T16:48:59ZengElsevierFarmacia Hospitalaria1130-63432171-86952017-09-0141560161010.7399/fh.10808Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in SpainSantiago Moreno Guillen0Juan Emilio Losa García1Juan Berenguer Berenguer2José Manuel Martínez Sesmero3Santiago Cenoz Gomis4Ruth Graefenhain5David Lopez Sanchez-Cambronero6Francisco Javier Parrondo Garcia7Servicio de Enfermedades Infecciosas. Hospital Ramon y Cajal, MadridSección Infecciosas. Departamento de Medicina Interna. Hospital Universitario Fundación Alcorcón, MadridServicio de Enfermedades Infecciosas. Hospital Gregorio Marañón, MadridDepartamento de Farmacia. Complejo hospitalario de Toledo, ToledoViiV Healthcare España, MadridViiV Healthcare España, MadridViiV Healthcare España, MadridJParrondoHealth Coslada – MadridObjective: Fixed-dose combinations of antiretroviral drugs have meant an important step forward in simplifying treatment and improving compliance and has led to an increased effectiveness of therapy, a viral load decrease and improving the quality of life of patients. The single-table formulation of dolutegravir with abacavir and lamivudine (DTG/ABC/3TC) is a highly efficacious and well-tolerated once-daily regimen for HIV-infected patients. The objective of the study was to assess the incremental cost-utility ratio of the fixed-dose combination of (DTG/ABC/3TC) versus the combinations emtricitabine/tenofovir/efavirenz (FTC/TDF/EFV), and darunavir/r (DRV/r) or raltegravir (RAL) with emtricitabine/tenofovir (FTC/TDF) or abacavir/lamivudine (ABC/3TC) as initial antiretroviral therapy in patients infected with HIV-1 from the perspective of the Spanish National Health System. Method: The ARAMIS model, which uses a microsimulation approach to simulate the individual changes in each patient from the start of treatment to death through a Markov chain of descriptive health states of the disease, was adapted to Spain. The alternatives used for comparison were the fixed-dose combination of emtricitabine/tenofovir/efavirenz (FTC/TDF/EFV), and the fixed- dose combinations of emtricitabine/tenofovir (FTC/TDF) or abacavir/lamivudine (ABC/3TC) with darunavir/r (DRV/r) or raltegravir (RAL). The probability of achieving virological suppression by the treatments included in the model was obtained from clinical trials SINGLE, SPRING-2 and FLAMINGO and the costs were expressed in € (2015). The model use the perspective of the Spanish National Health System, with a lifetime horizon and a discount rate of 3% was applied to cost and effectiveness. Results: Treatment initiation with DTG/ABC/3TC was dominant when it was compared with treatment initiation with all the comparators: vs. FTC/TDF/EFV (-67 210.71€/QALY), vs. DRV/r + FTC/TDF or ABC/3TC (-1 787 341.44€/QALY), and vs. RAL + FTC/TDF or ABC/3TC (-1 005 117.13€/QALY). All the sensitivity analyses performed showed the consistency of these findings. Conclusions: With the premises considered, treatment initiation with DTG/ABC/3TC STR appears to be the most cost-effective option in ARTnaïve HIV infected patients from the Spanish Health System perspectivehttp://www.aulamedica.es/fh/pdf/10808.pdfHIV treatmentComputer simulationCost-Utility analysis |
| spellingShingle | Santiago Moreno Guillen Juan Emilio Losa García Juan Berenguer Berenguer José Manuel Martínez Sesmero Santiago Cenoz Gomis Ruth Graefenhain David Lopez Sanchez-Cambronero Francisco Javier Parrondo Garcia Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain Farmacia Hospitalaria HIV treatment Computer simulation Cost-Utility analysis |
| title | Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain |
| title_full | Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain |
| title_fullStr | Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain |
| title_full_unstemmed | Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain |
| title_short | Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain |
| title_sort | cost utility analysis of the fixed dose combination of dolutegravir abacavir lamivudine as initial treatment of hiv patients in spain |
| topic | HIV treatment Computer simulation Cost-Utility analysis |
| url | http://www.aulamedica.es/fh/pdf/10808.pdf |
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