RTI Health Solutions, Research Triangle Park, NC 27709, USA.
Value Health. 2011 Jul-Aug;14(5):657-64. doi: 10.1016/j.jval.2011.01.009. Epub 2011 Jun 12.
To estimate the cost-effectiveness of once-daily tenofovir/emtricitabine compared with twice-daily zidovudine/lamivudine and once-daily abacavir/lamivudine in treatment-naïve adults with HIV-1 infection in the United States.
A Markov model with four therapy lines and six health states based on CD4(+) cell-count ranges was developed to estimate lifetime costs and health outcomes. Efficacy data (virologic response and CD4(+) cell-count changes) for first-line therapy were from 144-week results of Study 934 comparing tenofovir/emtricitabine with zidovudine/lamivudine and 48-week results of Study CNA30024 comparing abacavir/lamivudine with zidovudine/lamivudine, all in combination with efavirenz. Data from Study CNA30024 for abacavir/lamivudine were adjusted to allow for an indirect comparison with tenofovir/emtricitabine. Subsequent therapy lines were based on likely baskets of antiretroviral therapy recommended by US treatment guidelines. Utility values, mortality rates, and costs (2009 US dollars) were obtained from published sources. Base-case results were tested in sensitivity and variability analyses.
Average discounted results showed that individuals using tenofovir/emtricitabine were predicted to remain on first-line therapy for 7.7 years, accrue lifetime costs of $747,327, and experience 15.75 quality-adjusted life-years (QALYs), compared with 6.0 years, $777,090, and 15.68 QALYs for individuals using abacavir/lamivudine and 5.8 years, $778,287, and 15.44 QALYs for individuals using zidovudine/lamivudine. Tenofovir/emtricitabine was cost-effective compared with the other two first-line regimens in more than 75% of all probabilistic sensitivity analysis simulation runs for every willingness-to-pay threshold between $0 and $250,000 per QALY gained. Results were robust in variability and one-way sensitivity analyses.
Tenofovir/emtricitabine was predicted to be more effective and cost-saving compared with abacavir/lamivudine and zidovudine/lamivudine in treatment-naïve adults with HIV-1 infection in the United States.
评估替诺福韦/恩曲他滨每日 1 次方案与齐多夫定/拉米夫定每日 2 次方案和阿巴卡韦/拉米夫定每日 1 次方案相比，用于治疗初治 HIV-1 感染美国成人患者的成本效益。
采用马尔可夫模型，包含 4 条治疗线和 6 种健康状态，依据 CD4+细胞计数范围进行构建，以估计终生成本和健康结局。一线治疗的疗效数据（病毒学应答和 CD4+细胞计数变化）来自于比较替诺福韦/恩曲他滨与齐多夫定/拉米夫定的 144 周 934 研究和比较阿巴卡韦/拉米夫定与齐多夫定/拉米夫定的 48 周 CNA30024 研究，均联合应用依非韦伦。阿巴卡韦/拉米夫定的 CNA30024 研究数据经调整后可与替诺福韦/恩曲他滨进行间接比较。后续治疗线依据美国治疗指南推荐的可能的抗逆转录病毒治疗药物篮子。效用值、死亡率和成本（2009 年美元）均来自已发表的资料。基础病例结果经敏感度和变异性分析进行了检验。
平均折扣结果显示，使用替诺福韦/恩曲他滨的患者预计将继续使用一线治疗 7.7 年，终生费用为 747327 美元，获得 15.75 个质量调整生命年（QALY），而使用阿巴卡韦/拉米夫定的患者为 6.0 年、777090 美元和 15.68 QALY，使用齐多夫定/拉米夫定的患者为 5.8 年、778287 美元和 15.44 QALY。替诺福韦/恩曲他滨与其他两种一线方案相比，在每一种愿意支付的阈值（每获得 1 个 QALY 的费用在 0 美元至 250000 美元之间）下，在超过 75%的所有概率敏感性分析模拟运行中都具有成本效益。结果在变异性和单向敏感性分析中均具有稳健性。
替诺福韦/恩曲他滨在初治 HIV-1 感染美国成人患者中的疗效优于阿巴卡韦/拉米夫定和齐多夫定/拉米夫定，且成本更低。
