对感染人类免疫缺陷病毒的儿童进行抢先转换为基于依非韦伦的抗逆转录病毒疗法的成本效益分析

Cost-Effectiveness of Preemptive Switching to Efavirenz-Based Antiretroviral Therapy for Children With Human Immunodeficiency Virus.

作者信息

Desmonde Sophie, Frank Simone C, Coovadia Ashraf, Dahourou Désiré L, Hou Taige, Abrams Elaine J, Amorissani-Folquet Madeleine, Walensky Rochelle P, Strehlau Renate, Penazzato Martina, Freedberg Kenneth A, Kuhn Louise, Leroy Valeriane, Ciaranello Andrea L

机构信息

UMR 1027 Inserm, Université Paul Sabatier, Toulouse.

Bordeaux School of Public Health, France.

出版信息

Open Forum Infect Dis. 2019 Jun 11;6(7):ofz276. doi: 10.1093/ofid/ofz276. eCollection 2019 Jul.

DOI:10.1093/ofid/ofz276

PMID:31334298

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6634435/

Abstract

BACKGROUND

The NEVEREST-3 (South Africa) and MONOD-ANRS-12206 (Côte d'Ivoire, Burkina Faso) randomized trials found that switching to efavirenz (EFV) in human immunodeficiency virus-infected children >3 years old who were virologically suppressed by ritonavir-boosted lopinavir (LPV/r) was noninferior to continuing o LPV/r. We evaluated the cost-effectiveness of this strategy using the Cost-Effectiveness of Preventing AIDS Complications-Pediatric model.

METHODS

We examined 3 strategies in South African children aged ≥3 years who were virologically suppressed by LPV/r: (1) continued LPV/r, even in case of virologic failure, without second-line regimens; continued on LPV/r with second-line option after observed virologic failure; and preemptive switch to EFV-based antiretroviral therapy (ART), with return to LPV/r after observed virologic failure. We derived data on 24-week suppression (<1000 copies/mL) after a switch to EFV (98.4%) and the subsequent risk of virologic failure (LPV/r, 0.23%/mo; EFV, 0.15%/mo) from NEVEREST-3 data; we obtained ART costs (LPV/r, $6-$20/mo; EFV, $3-$6/mo) from published sources. We projected discounted life expectancy (LE) and lifetime costs per person. A secondary analysis used data from MONOD-ANRS-12206 in Côte d'Ivoire.

RESULTS

Continued LPV/r led to the shortest LE (18.2 years) and the highest per-person lifetime cost ($19 470). LPV/r with second-line option increased LE (19.9 years) and decreased per-person lifetime costs($16 070). Switching led to the longest LE (20.4 years) and the lowest per-person lifetime cost ($15 240); this strategy was cost saving under plausible variations in key parameters. Using MONOD-ANRS-12206 data in Côte d'Ivoire, the Switch strategy remained cost saving only compared with continued LPV/r, but the LPV/r with second-line option strategy was cost-effective compared with switching.

CONCLUSION

For children ≥3 years old and virologically suppressed by LPV/r-based ART, preemptive switching to EFV can improve long-term clinical outcomes and be cost saving.

CLINICAL TRIALS REGISTRATION

NCT01127204.

摘要

背景

NEVEREST - 3（南非）和MONOD - ANRS - 12206（科特迪瓦、布基纳法索）随机试验发现，对于接受洛匹那韦利托那韦（LPV/r）治疗且病毒学得到抑制的3岁以上人类免疫缺陷病毒感染儿童，换用依非韦伦（EFV）并不劣于继续使用LPV/r。我们使用预防艾滋病并发症 - 儿科模型评估了该策略的成本效益。

方法

我们研究了南非≥3岁且被LPV/r抑制病毒学的儿童的3种策略：（1）即使出现病毒学失败也继续使用LPV/r，不使用二线治疗方案；在观察到病毒学失败后继续使用LPV/r并选择二线治疗方案；以及抢先换用基于EFV的抗逆转录病毒疗法（ART），在观察到病毒学失败后再换回LPV/r。我们从NEVEREST - 3数据中得出换用EFV后24周病毒抑制（<1000拷贝/毫升）的数据（98.4%）以及随后病毒学失败的风险（LPV/r，0.23%/月；EFV，0.15%/月）；我们从已发表的资料中获取ART成本（LPV/r，6 - 20美元/月；EFV，3 - 6美元/月）。我们预测了贴现预期寿命（LE）和人均终身成本。二次分析使用了科特迪瓦MONOD - ANRS - 12206的数据。

结果

继续使用LPV/r导致最短的预期寿命（18.2年）和最高的人均终身成本（19470美元）。使用二线治疗方案的LPV/r增加了预期寿命（19.9年）并降低了人均终身成本（16070美元）。换用治疗导致最长的预期寿命（20.4年）和最低的人均终身成本（15240美元）；在关键参数的合理变化下，该策略具有成本节约效益。使用科特迪瓦MONOD - ANRS - 12206的数据，换用策略仅与继续使用LPV/r相比具有成本节约效益，但使用二线治疗方案的LPV/r策略与换用策略相比具有成本效益。