Value, Evidence & Outcomes, GlaxoSmithKline, Brentford, UK.
Medical Management, GlaxoSmithKline, Taipei, Taiwan.
Value Health Reg Issues. 2021 May;24:216-223. doi: 10.1016/j.vhri.2020.11.010. Epub 2021 Apr 12.
Although the efficacy of traditional 3-drug regimens for the treatment of HIV is well established, tolerability and toxicity concerns remain. New 2-drug regimens such as Juluca (dolutegravir [DTG]/rilpivirine [RPV]) offer noninferior efficacy versus 3-drug regimens (SWORD-1 and SWORD-2 studies), while reducing cumulative drug exposure and potentially long-term toxicities and drug-drug interactions. Here, we assess the cost-effectiveness of DTG/RPV for the treatment of HIV-1 for virologically suppressed adults in Taiwan.
A hybrid decision tree and Markov cohort state transition model was used to evaluate the expected economic costs and clinical outcomes associated with DTG/RPV and comparators. Model health states were defined by viral load and CD4 cell count. Efficacy and safety data were informed from SWORD-1 and SWORD-2 studies and the literature. The risk of long-term toxicities (cardiovascular disease, bone fractures, and chronic kidney disease) were included. Current branded drug acquisition prices were included, and healthcare costs informed by a bespoke costing study using National Health Insurance Research Database data. Incremental cost-effectiveness ratios were calculated and compared with a willingness-to-pay threshold of 2 times Taiwan's gross domestic product (NT$1 550 000).
DTG/RPV was found to be a cost-saving regimen compared to 3 comparators (rilpivirine [RPV]/emtricitabine [FTC]/tenofovir disoproxil fumarate [TDF], dolutegravir [DTG]/abacavir [ABC]/lamivudine [3TC], and elvitegravir [EVG]/cobicistat [c]/emtricitabine [FTC]/tenofovir alafenamide [TAF]) and fell in the southwest quadrant of the cost-effectiveness plane where it is generating significant savings with a small decrement in lifetime quality-adjusted life-years (-0.005). It was, however, more expensive than efavirenz [EFV]/emtricitabine [FTC]/ tenofovir disoproxil fumarate [TDF].
DTG/RPV is cost-saving compared to RPV/FTC/TDF, DTG/ABC/3TC, and EVG/c/FTC/TAF, and provides comparable efficacy with reduced cumulative drug exposure.
尽管传统的三联药物疗法治疗 HIV 的疗效已得到充分证实，但仍存在耐受性和毒性问题。新的二联药物疗法，如 Juluca（多替拉韦[DTG]/利匹韦林[RPV]）与三联药物疗法（SWORD-1 和 SWORD-2 研究）相比具有非劣效性，同时减少了累积药物暴露和潜在的长期毒性和药物相互作用。在这里，我们评估了 DTG/RPV 治疗台湾病毒学抑制的 HIV-1 成人患者的成本效益。
采用混合决策树和 Markov 队列状态转移模型，评估 DTG/RPV 与对照药物相关的预期经济成本和临床结果。模型健康状态由病毒载量和 CD4 细胞计数定义。疗效和安全性数据来自 SWORD-1 和 SWORD-2 研究和文献。包括长期毒性（心血管疾病、骨折和慢性肾脏病）的风险。包括当前品牌药物的收购价格，并使用国民健康保险研究数据库数据进行定制成本研究来提供医疗保健成本信息。计算增量成本效益比，并与台湾国内生产总值（NT$1 550 000）的 2 倍作为意愿支付阈值进行比较。
与 3 种对照药物（利匹韦林[RPV]/恩曲他滨[FTC]/替诺福韦富马酸酯[TDF]、多替拉韦[DTG]/阿巴卡韦[ABC]/拉米夫定[3TC]和艾维雷韦[EVG]/考比司他[c]/恩曲他滨[FTC]/替诺福韦艾拉酚胺[TAF]）相比，DTG/RPV 被发现是一种节省成本的治疗方案，并且在终生质量调整生命年（-0.005）略有下降的情况下，产生了显著的节省。然而，它比依非韦伦[EFV]/恩曲他滨[FTC]/替诺福韦富马酸酯[TDF]更昂贵。
与 RPV/FTC/TDF、DTG/ABC/3TC 和 EVG/c/FTC/TAF 相比，DTG/RPV 具有成本效益，并提供了可比的疗效，同时减少了累积药物暴露。
