多替拉韦作为俄罗斯初治的HIV-1感染患者一线治疗方案的成本效益

Cost-Effectiveness of Dolutegravir as a First-Line Treatment Option in the HIV-1-Infected Treatment-Naive Patients in Russia.

作者信息

Tremblay Gabriel, Chounta Vasiliki, Piercy James, Holbrook Tim, Garib Shan Ashton, Bukin Evgeny K, Punekar Yogesh Suresh

机构信息

Purple Squirrel Economics, New York, NY, USA.

ViiV Healthcare, Brentford, Middlesex, UK.

出版信息

Value Health Reg Issues. 2018 Sep;16:74-80. doi: 10.1016/j.vhri.2018.08.001. Epub 2018 Oct 5.

DOI:10.1016/j.vhri.2018.08.001

PMID:30296624

Abstract

OBJECTIVES

To evaluate the cost effectiveness of dolutegravir + abacavir/lamivudine (DTG + ABC/3TC) compared with raltegravir + abacavir/lamivudine (RAL + ABC/3TC) and ritonavir-boosted darunavir + abacavir/lamivudine (DRV/r + ABC/3TC) in HIV-1-infected treatment-naive patients in Russia.

METHODS

A dynamic Markov model was developed with five response states and six CD4-based health states. Efficacy estimated as probability of viral suppression (HIV RNA <50 copies/ml) at 48 weeks was obtained from a published network meta-analysis. Baseline cohort characteristics and health state utilities were informed using DTG phase 3 clinical trials. Health care resource use was obtained from literature and costed using published unit costs. Costs (presented in Russian rubles) included antiretroviral drug costs; HIV management costs such as routine care; costs of treating cardiovascular conditions, opportunistic infections, and drug-related adverse effects; and mortality costs. A patient lifetime analysis was conducted using the societal perspective. Outcomes were quality-adjusted life-years (QALYs), life-years, incremental cost per QALY ratio, and incremental cost per responder.

RESULTS

The viral suppression rate among patients receiving DTG + ABC/3TC was 71.7% compared with 65.2% for RAL + ABC/3TC and 59.6% for DRV/r + ABC/3TC. The mean duration of response per patient was 116.6 months for DTG + ABC/3TC, 108.6 months for RAL + ABC/3TC, and 98.9 months for DRV/r + ABC/3TC. Total discounted costs for treatment over patient lifetime were RUB 2.89, 5.32, and 4.38 million for DTG + ABC/3TC, RAL + ABC/3TC, and DRV/r + ABC/3TC, respectively. Lifetime discounted QALYs were 12.73 for patients on DTG + ABC/3TC and 12.72 each for patients on RAL + ABC/3TC and DRV/r + ABC/3TC. DTG + ABC/3TC thus dominated the other two alternatives.

CONCLUSIONS

With lower costs, higher response rates, and comparable QALYs, DTG + ABC/3TC can be considered as a cost-effective alternative.

摘要

目的

评估多替拉韦+阿巴卡韦/拉米夫定（DTG+ABC/3TC）与拉替拉韦+阿巴卡韦/拉米夫定（RAL+ABC/3TC）以及利托那韦增强的达芦那韦+阿巴卡韦/拉米夫定（DRV/r+ABC/3TC）相比，在俄罗斯初治的HIV-1感染患者中的成本效益。

方法

建立了一个动态马尔可夫模型，包含五个反应状态和六个基于CD4的健康状态。48周时病毒抑制（HIV RNA<50拷贝/ml）概率的疗效数据来自已发表的网络荟萃分析。基线队列特征和健康状态效用值通过DTG的3期临床试验获得。医疗保健资源使用情况来自文献，并使用已公布的单位成本进行成本核算。成本（以俄罗斯卢布表示）包括抗逆转录病毒药物成本；HIV管理成本，如常规护理；治疗心血管疾病、机会性感染和药物相关不良反应的成本；以及死亡成本。从社会角度进行患者终身分析。结果指标为质量调整生命年（QALY）、生命年、每QALY的增量成本比以及每应答者的增量成本。

结果

接受DTG+ABC/3TC治疗的患者病毒抑制率为71.7%，而接受RAL+ABC/3TC治疗的患者为65.2%，接受DRV/r+ABC/3TC治疗的患者为59.6%。DTG+ABC/3TC治疗的每位患者平均反应持续时间为116.6个月，RAL+ABC/3TC为108.6个月，DRV/r+ABC/3TC为98.9个月。患者终身治疗的总贴现成本，DTG+ABC/3TC为289万卢布，RAL+ABC/3TC为532万卢布，DRV/r+ABC/3TC为438万卢布。DTG+ABC/3TC治疗患者的终身贴现QALY为12.73，RAL+ABC/3TC和DRV/r+ABC/3TC治疗的患者均为12.72。因此，DTG+ABC/3TC优于其他两种方案。