Belay Yared Belete, Ali Eskinder Eshetu, Chung Karen Y, Gebretekle Gebremedhin Beedemariam, Sander Beate
School of Pharmacy, College of Health Sciences, Mekelle University, PO Box 1871, Mekelle, Ethiopia.
Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Pharmacoecon Open. 2021 Dec;5(4):655-664. doi: 10.1007/s41669-021-00275-6. Epub 2021 Jun 16.
In several countries, the dolutegravir (DTG)-based regimen is generally preferred as first-line antiretroviral therapy (ART) over the efavirenz (EFV)-based regimen, but the evidence in low-income countries is limited.
Our study aimed to evaluate the cost effectiveness of DTG- versus EFV-based first-line human immunodeficiency virus (HIV) treatment in Ethiopia.
We developed a microsimulation model for the progression of HIV/acquired immune deficiency syndrome (AIDS) to examine the cost effectiveness of DTG-based first-line ART compared with an EFV-based regimen from a healthcare payer perspective. We used a lifetime horizon with a 1-month cycle length and a 3% annual discount rate. The primary outcomes were a lifetime cost in US dollars ($), quality-adjusted life-months (QALMs) that converted to QALYs using the formula QALY = QALM/12, and incremental cost-effectiveness ratio (ICER). Deterministic sensitivity analysis was conducted to account for parameter uncertainty.
Compared with the EFV-based regimen, the DTG-based regimen was associated with an expected lifetime cost of $12,709 (vs. $12,701) and expected QALYs of 15.3 (vs. 14.7 QALYs) per patient, resulting in an ICER value of $13.33 per QALY. From an alternative analysis with a 5-year time horizon, DTG-based ART was found to be dominant, with expected gains of 0.17 QALYs at a lower cost of $1 per patient. The deterministic sensitivity analysis depicted that the maximum increase in ICER value was $72 per QALY, and all ICER values were below the estimated threshold value.
The DTG-based first-line regimen appears to be cost effective compared with the EFV-based regimen for the treatment of HIV/AIDS patients in an Ethiopian setting.
在一些国家，基于多替拉韦（DTG）的治疗方案通常比基于依非韦伦（EFV）的治疗方案更受青睐，被用作一线抗逆转录病毒疗法（ART），但在低收入国家，相关证据有限。
我们的研究旨在评估在埃塞俄比亚，基于DTG与基于EFV的一线人类免疫缺陷病毒（HIV）治疗的成本效益。
我们建立了一个关于HIV/获得性免疫缺陷综合征（AIDS）进展的微观模拟模型，从医疗保健支付者的角度，研究基于DTG的一线ART与基于EFV的治疗方案相比的成本效益。我们采用终身视角，周期长度为1个月，年贴现率为3%。主要结果包括以美元（$）计的终身成本、使用公式QALY = QALM/12转换为质量调整生命年（QALY）的质量调整生命月（QALM），以及增量成本效益比（ICER）。进行确定性敏感性分析以考虑参数不确定性。
与基于EFV 的治疗方案相比，基于DTG的治疗方案每位患者的预期终身成本为12,709美元（对比12,701美元），预期QALY为15.3（对比14.7 QALY），导致ICER值为每QALY 13.33美元。从一个5年时间范围的替代分析来看，基于DTG的ART被发现占优，预期增益为0.17 QALY，每位患者成本降低1美元。确定性敏感性分析表明，ICER值的最大增幅为每QALY 72美元，且所有ICER值均低于估计的阈值。
在埃塞俄比亚的环境中，对于治疗HIV/AIDS患者，基于DTG的一线治疗方案与基于EFV的治疗方案相比似乎具有成本效益。
