Restelli Umberto, Fabbiani Massimiliano, Di Giambenedetto Simona, Nappi Carmela, Croce Davide
Centre for Research on Health Economics, Social and Health Care Management (CREMS), LIUC - Università Cattaneo, Castellanza, Italy; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart.
Clinicoecon Outcomes Res. 2017 Mar 1;9:173-179. doi: 10.2147/CEOR.S127097. eCollection 2017.
This analysis aimed at evaluating the impact of a therapeutic strategy of treatment simplification of atazanavir (ATV)+ ritonavir (r) + lamivudine (3TC) in virologically suppressed patients receiving ATV+r+2 nucleoside reverse transcriptase inhibitors (NRTIs) on the budget of the Italian National Health Service (NHS).
A budget impact model with a 5-year time horizon was developed based on the clinical data of Atlas-M trial at 48 weeks (in terms of percentage of patients experiencing virologic failure and adverse events), from the Italian NHS perspective. A scenario in which the simplification strategy was not considered was compared with three scenarios in which, among a target population of 1,892 patients, different simplification strategies were taken into consideration in terms of percentage of patients simplified on a yearly basis among those eligible for simplification. The costs considered were direct medical costs related to antiretroviral drugs, adverse events management, and monitoring activities.
The percentage of patients of the target population receiving ATV+r+3TC varies among the scenarios and is between 18.7% and 46.9% in year 1, increasing up to 56.3% and 84.4% in year 5. The antiretroviral treatment simplification strategy considered would lead to lower costs for the Italian NHS in a 5-year time horizon between -28.7 million € and -16.0 million €, with a reduction of costs between -22.1% (-3.6 million €) and -8.8% (-1.4 million €) in year 1 and up to -39.9% (-6.9 million €) and -26.6% (-4.6 million €) in year 5.
The therapy simplification for patients receiving ATV+r+2 NRTIs to ATV+r+3TC at a national level would lead to a reduction of direct medical costs over a 5-year period for the Italian NHS.
本分析旨在评估在接受阿扎那韦（ATV）+利托那韦（r）+拉米夫定（3TC）治疗且病毒学得到抑制的患者中，将ATV+r+两种核苷类逆转录酶抑制剂（NRTIs）的治疗方案简化后，对意大利国家医疗服务体系（NHS）预算的影响。
从意大利NHS的角度出发，基于阿特拉斯-M试验48周的临床数据（从病毒学失败和不良事件患者的百分比方面），开发了一个为期5年的预算影响模型。将未考虑简化策略的情景与三种情景进行比较，在这三种情景中，在1892名目标患者群体中，根据每年可简化患者中简化患者的百分比，考虑了不同的简化策略。所考虑的成本包括与抗逆转录病毒药物、不良事件管理和监测活动相关的直接医疗成本。
目标人群中接受ATV+r+3TC治疗的患者百分比在各情景中有所不同，第1年在18.7%至46.9%之间，第5年增至56.3%至84.4%。所考虑的抗逆转录病毒治疗简化策略将使意大利NHS在5年时间内成本降低，降低幅度在-2870万欧元至-1600万欧元之间，第1年成本降低幅度在-22.1%（-360万欧元）至-8.8%（-140万欧元）之间，第5年高达-39.9%（-690万欧元）至-26.6%（-460万欧元）。
在全国范围内，将接受ATV+r+两种NRTIs治疗的患者治疗方案简化为ATV+r+3TC，将使意大利NHS在5年内直接医疗成本降低。
