Escobar Ismael, Pulido Federico, Pérez Esther, Arribas José Ramón, García María Pilar, Hernando Asunción
Servicio de Farmacia, Hospital Universitario 12 de Octubre, Madrid, España.
Enferm Infecc Microbiol Clin. 2006 Oct;24(8):490-4. doi: 10.1157/13092464.
To conduct a cost-efficacy analysis of lopinavir/ritonavir (LPV/r) monotherapy as a maintenance regimen following induction of virological response with triple therapy including LPV/r. The pharmacoeconomic analysis was performed from the perspective of the Spanish public health system.
A cost-efficacy analysis was performed in a phase IV-II, comparative, randomized, multicenter, open-label clinical trial evaluating the efficacy and safety of maintenance therapy with LPV/r monotherapy versus continuation of triple therapy in HIV-infected patients with a persistently undetectable viral load for 6 months. For the pharmacoeconomic analysis, efficacy was defined as the proportion of patients with plasma HIV RNA concentrations < 50 copies/mL at 48 weeks from the start of the study. An intent-to-treat analysis was performed. Only direct costs were considered. Cost, efficacy and the cost-efficacy ratio were calculated for each treatment option.
The cost-efficacy ratio of LPV/r maintenance monotherapy was 5186 euros per unit of achieved effect (patient with plasma HIV RNA concentrations < 50 copies/mL at 48 weeks), whereas maintenance with triple therapy had a cost-efficacy ratio of 8688 euros per unit of achieved effect.
The option of LPV/r monotherapy as maintenance therapy in HIV-infected patients following induction of virological response with triple therapy including LPV/r might be a more efficient alternative than maintaining triple therapy, as evidenced by a more favorable cost-efficacy ratio.
对洛匹那韦/利托那韦（LPV/r）单药治疗作为含LPV/r的三联疗法诱导病毒学应答后的维持方案进行成本效益分析。药物经济学分析是从西班牙公共卫生系统的角度进行的。
在一项IV-II期、比较性、随机、多中心、开放标签的临床试验中进行成本效益分析，该试验评估了LPV/r单药维持治疗与继续三联疗法对病毒载量持续检测不到6个月的HIV感染患者的疗效和安全性。对于药物经济学分析，疗效定义为从研究开始48周时血浆HIV RNA浓度<50拷贝/mL的患者比例。进行了意向性分析。仅考虑直接成本。计算了每种治疗方案的成本、疗效和成本效益比。
LPV/r维持单药治疗的成本效益比为每获得一个单位效果（48周时血浆HIV RNA浓度<50拷贝/mL的患者）5186欧元，而三联疗法维持治疗的成本效益比为每获得一个单位效果8688欧元。
对于接受含LPV/r的三联疗法诱导病毒学应答后的HIV感染患者，LPV/r单药治疗作为维持疗法可能是比维持三联疗法更有效的选择，更有利的成本效益比证明了这一点。
