利用英国抗逆转录病毒药物价格对 MONET 试验进行成本效益分析。

Cost-efficacy analysis of the MONET trial using UK antiretroviral drug prices.

机构信息

Chelsea and Westminster Hospital, London, UK.

出版信息

Appl Health Econ Health Policy. 2011 Jul 1;9(4):217-23. doi: 10.2165/11592220-000000000-00000.

DOI:10.2165/11592220-000000000-00000

PMID:21682350

Abstract

BACKGROUND

In virologically suppressed patients, switching to darunavir/ritonavir (DRV/r) monotherapy maintains HIV RNA suppression, and could also lower treatment costs.

OBJECTIVE

The purpose of this analysis was to calculate the potential cost savings from the use of DRV/r monotherapy in the UK.

METHODS

In the MONET trial, 256 patients with HIV RNA < 50 copies/mL on current highly active antiretroviral therapy (HAART) for over 24 weeks (non-nucleoside reverse-transcriptase inhibitor [NNRTI] based [43%] or protease inhibitor [PI] based [57%]), switched to DRV/r 800/100 mg once daily, either as monotherapy (n = 127) or with two NRTIs (n = 129). The UK costs per patient with HIV RNA < 50 copies/mL at week 48 (responders) were calculated using a 'switch included' analysis to account for additional antiretrovirals taken after initial treatment failure. By this analysis, efficacy was 93.5% versus 95.1% in the DRV/r monotherapy and triple therapy arms, respectively. British National Formulary 2009 values were used.

RESULTS

Before the trial, the mean annual cost of antiretrovirals was £6906 for patients receiving NNRTI-based HAART, and £8348 for patients receiving PI-based HAART. During the MONET trial, the mean annual per-patient cost of antiretrovirals was £8642 in the triple therapy arm, of which 55% was from NRTIs and 45% from PIs. The mean per-patient cost in the monotherapy arm was £4126, a saving of 52% versus triple therapy. The mean cost per responder was £9085 in the triple therapy arm versus £4413 in the DRV/r monotherapy arm.

CONCLUSIONS

Based on the MONET results, the lower cost of DRV/r monotherapy versus triple therapy in the UK would allow more patients to be treated for fixed budgets, while maintaining HIV RNA suppression at < 50 copies/mL. If all patients meeting the inclusion criteria of the MONET trial in the UK were switched to DRV/r monotherapy, there is the potential to save up to £60 million in antiretroviral drug costs from the UK NHS budget.

摘要

背景

在病毒学抑制的患者中，转换为达芦那韦/利托那韦（DRV/r）单药治疗可维持 HIV RNA 抑制，并且还可以降低治疗费用。

目的

本分析旨在计算在英国使用 DRV/r 单药治疗的潜在成本节约。

方法

在 MONET 试验中，256 名 HIV RNA <50 拷贝/mL 的患者接受了超过 24 周的当前高效抗逆转录病毒治疗（HAART）（非核苷逆转录酶抑制剂[NNRTI]为基础[43%]或蛋白酶抑制剂[PI]为基础[57%]），转换为 DRV/r 800/100 mg 每日一次，无论是单药治疗（n = 127）还是与两种 NRTIs 联合治疗（n = 129）。在第 48 周（应答者），使用“包含转换”分析计算每例 HIV RNA <50 拷贝/mL 的患者的英国成本，以考虑初始治疗失败后服用的其他抗逆转录病毒药物。根据这项分析，DRV/r 单药治疗和三联治疗组的疗效分别为 93.5%和 95.1%。使用 2009 年英国国家处方集（British National Formulary）值。

结果

在试验之前，接受 NNRTI 为基础的 HAART 的患者的抗逆转录病毒药物年平均费用为 6906 英镑，接受 PI 为基础的 HAART 的患者为 8348 英镑。在 MONET 试验期间，三联治疗组的每位患者的年平均抗逆转录病毒药物费用为 8642 英镑，其中 55%来自 NRTIs，45%来自 PIs。单药治疗组的每位患者的平均费用为 4126 英镑，与三联治疗组相比节省了 52%。三联治疗组的每位应答者的平均费用为 9085 英镑，而 DRV/r 单药治疗组为 4413 英镑。

结论

根据 MONET 研究结果，与三联治疗相比，DRV/r 单药治疗在英国的成本更低，在维持 HIV RNA 抑制低于 50 拷贝/mL 的同时，可以让更多的患者接受治疗。如果英国所有符合 MONET 试验纳入标准的患者都转换为 DRV/r 单药治疗，英国国民保健制度（NHS）预算中的抗逆转录病毒药物费用可能节省高达 6000 万英镑。