Health Economics Research Unit, Social Security Mexican Institute, Mexico City, Mexico.
Value Health. 2010 Dec;13(8):903-14. doi: 10.1111/j.1524-4733.2010.00798.x. Epub 2010 Nov 22.
Maraviroc is the first approved drug in a new class of antiretrovirals, the CCR5 antagonists. The objective of this study was to predict the long-term clinical impact and cost-effectiveness of maraviroc in treatment-experienced adults with HIV/AIDS in Mexico.
The AntiRetroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model was adapted to the Mexican context to predict clinical and economic outcomes of treating with optimized background therapy (OBT) versus testing for viral tropism status and treating with OBT ± maraviroc accordingly in treatment-experienced adults in Mexico. Baseline characteristics and efficacy were from the MOTIVATE trials' screening cohort. Costs and population mortality data were specific to Mexico. Results were reported from the perspective of health care payers in 2008 Mexican pesos (converted to 2008 US$ in parentheses).
Compared to treatment with OBT alone, treatment with OBT ± maraviroc contingent on tropism test result increased projected undiscounted life expectancy and discounted quality-adjusted life expectancy from 7.54 to 8.71 years and 4.42 to 4.92 quality-adjusted life years (QALYs), respectively, at an incremental cost of $228,215 (US$21,329). The resultant incremental cost-effectiveness ratio (ICER) was $453,978 (US$42,429) per QALY gained. The ICER was somewhat lower when maraviroc was modeled in individuals susceptible to ≤ 2 components of OBT ($407,329; US$38,069), while the ICER was higher in individuals susceptible to ≥3 OBT components ($718,718; US$67,171).
In treatment-experienced individuals with HIV/AIDS in Mexico, maraviroc may be cost-effective, particularly in individuals with limited options for active antiretroviral therapy (ART).
马拉维若（maraviroc）是首个获准用于治疗艾滋病的新型抗逆转录病毒药物，属于 CCR5 拮抗剂。本研究旨在预测马拉维若在墨西哥有治疗经验的 HIV/AIDS 成人患者中的长期临床影响和成本效益。
采用蒙特卡罗个体模拟分析（ARAMIS）模型，根据墨西哥的具体情况进行调整，以预测在有治疗经验的墨西哥成年人中，采用优化背景治疗（OBT）与检测病毒嗜性并相应采用 OBT±马拉维若治疗相比，采用 OBT 治疗的临床和经济结局。基线特征和疗效数据来源于 MOTIVATE 试验的筛选队列，成本和人群死亡率数据则是墨西哥特有的。结果以 2008 年墨西哥比索（括号内为转换为 2008 年美元）的卫生保健支付者角度进行报告。
与仅采用 OBT 治疗相比，根据病毒嗜性检测结果，采用 OBT±马拉维若治疗方案使预期未贴现生命预期和贴现质量调整生命预期分别从 7.54 年增加到 8.71 年和从 4.42 年增加到 4.92 年质量调整生命年（QALY），增量成本为 228,215 美元（21,329 美元）。增量成本效益比（ICER）为每增加一个 QALY 需 453,978 美元（42,429 美元）。当马拉维若用于对 OBT 中≤2 种成分敏感的个体模型中时，ICER 略低（407,329 美元，38,069 美元），而当马拉维若用于对 OBT 中≥3 种成分敏感的个体模型中时，ICER 则较高（718,718 美元，67,171 美元）。
在墨西哥有治疗经验的 HIV/AIDS 个体中，马拉维若可能具有成本效益，尤其是在可供选择的抗逆转录病毒治疗（ART）有限的个体中。
