Wang Wenjuan, Zhou Dachuang, Zhou Kejia, Zhang Di, Li Hao, Zhang Hongliu, Jiang Xin, Wang Ruihua, Wang Xi, Tang Wenxi
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu Province, 211198, People's Republic of China.
Infection Center, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
Clinicoecon Outcomes Res. 2025 May 23;17:393-406. doi: 10.2147/CEOR.S513601. eCollection 2025.
This study aims to evaluate the economic value of Bictegravir/emtricitabine/tenofovir (B/F/TAF) as a first-line treatment for HIV-1 infection in China, where such evaluations are currently lacking.
We developed a monthly-cycle Markov model to evaluate the economics of B/F/TAF versus dolutegravir/lamivudine (DTG/3TC) as a first-line ART for adult HIV-1 patients over a lifelong time. The social costs, quality-adjusted life years (QALYs), incremental net monetary benefit (INMB), and incremental cost-effectiveness ratio (ICER) have been analyzed using health economic methods. Sensitivity analyses were conducted for the result validation. Taking into account the transmissibility of HIV, we have developed a scenario within a dynamic model across the entire population in China, to conduct a health economic evaluation of the two drugs over 30 years. Model precision was tested using relative standard deviation (RSD).
In the Markov model, B/F/TAF had higher per-person costs compared to DTG/3TC ($44,381.33 vs $42,160.13), but also resulted in greater QALYs (11.6771 vs 11.5389), leading to a per-person INMB of $3072.26 (WTP = 3GDP) and an ICER of $16,052.42 per QALY. Uncertainty analyses confirmed the robustness of these results. The dynamic model further indicated that B/F/TAF was both cost-benefit and cost-effective, with a per-person INMB of $7.33 (WTP = 3GDP) and an ICER of $7,953.72 per QALY, although it exhibited a higher RSD.
After adopting the B/F/TAF regimen in China, the cost-benefit and cost-effectiveness of HIV prevention and treatment have significantly improved. We should advocate for B/F/TAF as the first-line treatment to enhance HIV management.
本研究旨在评估比克替拉韦/恩曲他滨/替诺福韦（B/F/TAF）作为中国HIV-1感染一线治疗方案的经济价值，目前中国尚缺乏此类评估。
我们构建了一个月度周期马尔可夫模型，以评估B/F/TAF与多替拉韦/拉米夫定（DTG/3TC）作为成人HIV-1患者终身一线抗逆转录病毒治疗（ART）的经济学情况。使用卫生经济学方法分析了社会成本、质量调整生命年（QALY）、增量净货币效益（INMB）和增量成本效益比（ICER）。进行敏感性分析以验证结果。考虑到HIV的传播性，我们在一个针对中国全体人群的动态模型中设定了一个情景，对这两种药物进行30年的卫生经济学评估。使用相对标准差（RSD）测试模型精度。
在马尔可夫模型中，与DTG/3TC相比，B/F/TAF的人均成本更高（44,381.33美元对42,160.13美元），但也带来了更多的QALY（11.6771对11.5389），导致人均INMB为3072.26美元（意愿支付 = 3倍国内生产总值），每QALY的ICER为16,052.42美元。不确定性分析证实了这些结果的稳健性。动态模型进一步表明，B/F/TAF既有成本效益又具有成本效果，人均INMB为7.33美元（意愿支付 = 3倍国内生产总值），每QALY的ICER为7,953.72美元，尽管其RSD较高。
在中国采用B/F/TAF方案后，HIV预防和治疗的成本效益和成本效果有了显著改善。我们应提倡将B/F/TAF作为一线治疗方案以加强HIV管理。
