RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
Georgetown University School of Medicine, Georgetown University, Washington, DC, 20057, USA.
Pharmacoeconomics. 2021 Apr;39(4):421-432. doi: 10.1007/s40273-020-00992-6. Epub 2021 Feb 3.
Ibalizumab-uiyk (ibalizumab) is a first-in-class, long-acting, postattachment HIV-1 inhibitor for adults with multidrug-resistant (MDR) HIV-1 infection. This analysis examines the cost-effectiveness and budget impact of ibalizumab treatment for this difficult-to-treat population in the United States.
A Markov model followed cohorts of adults with MDR HIV-1 infection through two final lines of antiretroviral therapy: ibalizumab + optimized background therapy (OBT) or OBT alone followed by nonsuppressive therapy. Model inputs were based on ibalizumab clinical trial data, market uptake projections, and published literature, with costs in 2019 dollars. The cost-effectiveness analysis assessed costs and health outcomes from a health care sector perspective for individuals receiving ibalizumab + OBT versus OBT alone over a lifetime time horizon. The budget-impact analysis estimated the impact on payer budgets of the introduction of ibalizumab over 3 years for a hypothetical commercial health plan.
Compared with individuals receiving OBT alone, individuals receiving ibalizumab + OBT incurred higher costs but lived longer, healthier lives, with an incremental cost of $133,040 per QALY gained. For a hypothetical commercial health plan with 1 million members, the introduction of ibalizumab + OBT was estimated to increase budgets by $217,260, $385,245, and $560,310 ($0.018, $0.032, and $0.047 per member per month) in years 1, 2, and 3, respectively. These results were found to be robust in sensitivity and scenario analyses.
Ibalizumab may represent a cost-effective and affordable option to improve health outcomes for individuals with MDR HIV-1 infection.
ibalizumab-uiyk（ibalizumab）是一种首创的长效、后附着 HIV-1 抑制剂，适用于患有多重耐药（MDR）HIV-1 感染的成人。本分析研究了ibalizumab 治疗美国这种难治性人群的成本效益和预算影响。
一个马尔可夫模型对接受 MDR HIV-1 感染的成年人队列进行了随访，通过两种最终的抗逆转录病毒治疗：ibalizumab+优化背景治疗（OBT）或 OBT 单独治疗后转为非抑制性治疗。模型输入基于 ibalizumab 临床试验数据、市场采用预测和已发表的文献，以 2019 年美元计价。成本效益分析从医疗保健部门的角度评估了接受 ibalizumab+OBT 与单独接受 OBT 的个体在一生中的成本和健康结果。预算影响分析估计了在三年内引入 ibalizumab 对假设商业健康计划支付方预算的影响。
与单独接受 OBT 的个体相比，接受 ibalizumab+OBT 的个体的成本更高，但寿命更长、生活质量更好，每获得一个质量调整生命年（QALY）的增量成本为 133,040 美元。对于一个拥有 100 万成员的假设商业健康计划，引入 ibalizumab+OBT 预计将使预算在第 1、2 和 3 年分别增加 217,260、385,245 和 560,310 美元（每位成员每月 0.018、0.032 和 0.047 美元）。这些结果在敏感性和情景分析中是稳健的。
ibalizumab 可能是一种具有成本效益和负担得起的选择，可以改善 MDR HIV-1 感染个体的健康结果。
