Estrada Vicente, Górgolas Miguel, Peña José A, Tortajada Elena, Castro Antonio, Presa María, Oyagüez Itziar
Department of Infectious Diseases, Hospital Clínico San Carlos, Madrid, Spain.
Department of Infectious Diseases, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Pharmacoecon Open. 2022 May;6(3):415-424. doi: 10.1007/s41669-022-00322-w. Epub 2022 Feb 5.
This study aimed to assess the potential epidemiological and economic impact of rapid initiation of human immunodeficiency virus (HIV) treatment with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) on HIV transmission compared with the current initiation observed in clinical practice in Spain.
A transmission model was adapted to estimate the cumulative HIV infection incidence and potential cost savings based on the number of HIV infections prevented among men who have sex with men, heterosexual males and females, and people who inject drugs (PWID) over a 20-year time horizon. The analysis compared rapid antiretroviral therapy (ART) initiation with B/F/TAF (9 days from diagnosis until treatment initiation) versus current ART initiation practice (with an average of 35 days from diagnosis to treatment). People living with HIV were distributed according to their treatment status. Risk for transmission was assigned to undiagnosed, diagnosed in care and not receiving ART, and receiving ART but virally unsuppressed, which was estimated by sexual contact, needles and syringes shared among PWID, state of HIV infection, and ART use.
In the base-case analysis, rapid ART initiation with B/F/TAF is expected to prevent 992 new HIV infections over the next 20 years compared with current ART initiation practices. Considering the lifetime costs of treating HIV infection, the reduction in HIV incidence could result in potential cost savings of €323 million.
These results suggest that rapid ART initiation with B/F/TAF in newly diagnosed patients with HIV is a high-value strategy for the Spanish National Health System and society, reducing HIV incidence and thereby reducing future related direct and indirect costs of care.
本研究旨在评估与西班牙临床实践中目前观察到的启动治疗情况相比，使用比克替拉韦/恩曲他滨/替诺福韦艾拉酚胺（B/F/TAF）快速启动人类免疫缺陷病毒（HIV）治疗对HIV传播的潜在流行病学和经济影响。
采用一种传播模型，根据在20年时间范围内男男性行为者、异性恋男性和女性以及注射毒品者（PWID）中预防的HIV感染数量，估计累积HIV感染发病率和潜在成本节约。该分析将使用B/F/TAF快速启动抗逆转录病毒治疗（ART）（从诊断到开始治疗9天）与目前的ART启动实践（从诊断到治疗平均35天）进行比较。HIV感染者根据其治疗状态进行分布。将传播风险分配给未诊断、已诊断但未接受ART以及接受ART但病毒未得到抑制的人群，通过性接触、PWID共用针头和注射器、HIV感染状态以及ART使用情况来估计传播风险。
在基础病例分析中，与目前的ART启动实践相比，使用B/F/TAF快速启动ART预计在未来20年内可预防992例新的HIV感染。考虑到治疗HIV感染的终身成本，HIV发病率的降低可能带来3.23亿欧元的潜在成本节约。
这些结果表明，对于西班牙国家卫生系统和社会而言，在新诊断的HIV患者中使用B/F/TAF快速启动ART是一项高价值策略，可降低HIV发病率，从而减少未来相关的直接和间接护理成本。
