University of Nigeria Nsukka, Department of Clinical Pharmacy and Pharmacy Management.
University of Nigeria Teaching Hospital, Department of Pharmaceutical Services.
Afr Health Sci. 2023 Mar;23(1):157-169. doi: 10.4314/ahs.v23i1.18.
Dolutegravir (DTG) based antiretroviral therapy (ART) has largely replaced Efavirenz (EFV) based therapy as the preferred first-line regimen in the treatment of adults with HIV. This study was carried out to evaluate the comparative cost-effectiveness of DTG and EFV-based ART in HIV-infected treatment-naïve patients in a treatment centre in Nigeria.
This was a retrospective case-control study of patients initiated on DTG vs. EFV-based regimens from January 2018 to December 2019 at the APIN/HAVARD clinic of Nigeria's Jos University Teaching Hospital. The current viral load result was used to determine treatment effectiveness using a benchmark of ≤200 copies/mL. Sensitivity analysis was carried out to ensure the robustness of the benchmark. The total cost of treatment was obtained by summing up the relevant cost components. Appropriate descriptive and inferential statistics were employed in data analysis using Statistical Product and Services Solutions (SPSS) V.25. The incremental cost-effectiveness ratio of DTG compared to EFV was presented as cost/effectiveness.
Treatment was effective in 42(51.9%) and 58(71.6%) patients initiated on DTG and EFV-based regimen, respectively. The incremental cost-effective ratio (ICER) of patients on DTG compared to those on EFV was $10.5076 per effectiveness, which was less than 1% of the Nigerian 2019 per capita Gross Domestic Product. Sensitivity analysis showed the robustness of the result.
Efavirenz based regimen had higher treatment effectiveness than DTG-based regimen in treatment-naive patients after initiating treatment in a short term. Compared to EFV, DTG-based regimen is cost-effective in the management of treatment naïve HIV patients.
多替拉韦（DTG）为基础的抗逆转录病毒疗法（ART）在治疗 HIV 感染者方面已基本取代依非韦伦（EFV）为基础的疗法，成为首选的一线治疗方案。本研究旨在评估尼日利亚一家治疗中心初治 HIV 感染者中 DTG 和 EFV 为基础的 ART 的成本效果比较。
这是一项回顾性病例对照研究，研究对象为 2018 年 1 月至 2019 年 12 月期间在尼日利亚乔斯大学教学医院的 APIN/HAVARD 诊所接受 DTG 或 EFV 为基础的方案治疗的初治患者。使用≤200 拷贝/ml 的基准来确定当前病毒载量结果以评估治疗效果。进行敏感性分析以确保基准的稳健性。通过汇总相关成本构成部分来获得治疗总成本。使用统计产品与服务解决方案（SPSS）V.25 进行数据分析时采用了适当的描述性和推断性统计。DTG 与 EFV 相比的增量成本效果比表示为成本/效果。
分别有 42（51.9%）和 58（71.6%）名接受 DTG 和 EFV 为基础的方案治疗的患者治疗有效。与 EFV 相比，接受 DTG 治疗的患者的增量成本效果比（ICER）为每增加一个有效结果 10.5076 美元，低于尼日利亚 2019 年人均国内生产总值的 1%。敏感性分析显示结果稳健。
在短期治疗开始后，初治患者中 EFV 为基础的方案比 DTG 为基础的方案具有更高的治疗效果。与 EFV 相比，DTG 为基础的方案在治疗初治 HIV 患者方面具有成本效果。
