Department of Pharmacology University of Liverpool, Liverpool, UK.
Pharmacoeconomics. 2010;28 Suppl 1:69-81. doi: 10.2165/11587460-000000000-00000.
Very few studies have evaluated the cost of highly active antiretroviral therapy (HAART) per successful treatment in HIV-infected patients.
To evaluate the cost of achieving undetectable plasma HIV-RNA levels in highly treatment-experienced, HIV-1-infected adults receiving darunavir/ritonavir (DRV/r 600 mg/100 mg twice a day) or control protease inhibitor (PI)-based HAART.
The mean annual per-patient cost of DRV/r and control PI-based HAART was determined from the proportional use of antiretroviral agents in the DRV/r and control PI arms of the pooled POWER 1 and 2 trials, applying drug acquisition costs for 13 healthcare settings. The mean annual cost per patient of achieving undetectable plasma HIV-RNA levels (<50 copies/mL) was calculated by dividing the cost of each treatment by the proportion of patients with undetectable plasma HIV-RNA levels after 48 weeks in the DRV/r (45%) and control PI (10%) arms of the POWER trials.
Whereas absolute costs of treatment were 1-19% higher with DRV/r versus control PI-based HAART depending on the healthcare setting, the mean annual per-patient cost of achieving undetectable plasma HIV-RNA levels was 73-78% lower. These cost savings were maintained in the sensitivity analyses, adjusting for control PI and enfuvirtide use, and the number of active drugs in the background regimen. The incremental annual cost per additional patient achieving undetectable plasma HIV-RNA levels with DRV/r versus control PI-based HAART in POWER 1 and 2 (£4148) compared favourably with that determined for enfuvirtide (£137, 740; TORO trials) and tipranavir/ritonavir (£32,176; RESIST) versus control therapy.
DRV/r-based HAART provided consistent reductions in the cost of achieving undetectable plasma HIV-RNA levels compared with control PI-based therapy in highly treatment-experienced patients across various healthcare settings. The incremental cost per additional patient achieving undetectable plasma HIV-RNA levels with DRV/r versus control PI-based HAART was also lower than that calculated for other treatment options in this population. These results suggest that DRV/r is an economically viable option for highly treatment-experienced patients.
很少有研究评估在接受高效抗逆转录病毒治疗（HAART）的 HIV 感染者中，每例成功治疗的成本。
评估达芦那韦/利托那韦（DRV/r）600mg/100mg，每日两次或对照蛋白酶抑制剂（PI）为基础的 HAART 治疗中，治疗经验丰富的 HIV-1 感染成人中达到不可检测的血浆 HIV-RNA 水平的成本。
从 POWER 1 和 2 研究的 DRV/r 和对照 PI 臂中，按比例使用抗逆转录病毒药物，确定达芦那韦/利托那韦和对照 PI 为基础的 HAART 的每位患者每年的平均费用，应用 13 种医疗保健环境下的药物获得成本。通过将治疗的每位患者的成本除以 DRV/r（45%）和对照 PI（10%）臂中 48 周时不可检测的血浆 HIV-RNA 水平的患者比例，计算达到不可检测的血浆 HIV-RNA 水平（<50 拷贝/ml）的每位患者每年的平均成本。
在不同的医疗保健环境下，与对照 PI 为基础的 HAART 相比，DRV/r 治疗的绝对成本高 1%-19%，但达到不可检测的血浆 HIV-RNA 水平的每位患者的年平均成本低 73%-78%。在敏感性分析中，通过调整对照 PI 和恩夫韦肽的使用以及背景方案中活性药物的数量，这些成本节约得以维持。与恩夫韦肽（TORO 试验）和替拉那韦/利托那韦（RESIST）与对照治疗相比，POWER 1 和 2 中，与对照 PI 为基础的 HAART 相比，DRV/r 治疗中每增加一名达到不可检测的血浆 HIV-RNA 水平的患者的每年增量成本（4148 英镑）对患者更有利。
在各种医疗保健环境下，与对照 PI 为基础的治疗相比，DRV/r 为基础的 HAART 治疗在治疗经验丰富的患者中，在达到不可检测的血浆 HIV-RNA 水平方面具有一致的成本降低作用。与对照 PI 为基础的 HAART 相比，DRV/r 治疗中每增加一名达到不可检测的血浆 HIV-RNA 水平的患者的增量成本也低于该人群中其他治疗选择的计算成本。这些结果表明，DRV/r 是治疗经验丰富的患者的一种具有经济可行性的选择。
