Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain
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| Format: | Artículo científico |
| Langue: | en |
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Sociedad Española de Farmacia Hospitalaria
2017
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| _version_ | 1876453516884574208 |
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| author | Santiago Moreno Guillén |
| author_facet | Santiago Moreno Guillén |
| contents | Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain Santiago Moreno Guillén Juan Emilio Losa García Juan Berenguer Berenguer José Manuel Martínez Sesmero Santiago Cenoz Gomis Ruth Graefehain David López Sánchez-Cambronero Francisco Javier Parrondo García Medicina Cost HIV treatment Utility analysis Computer simulation Objective: Fixed-dose combinations of antiretroviral drugs have meant an important step forward in simplifying treatment and improving com-pliance and has led to an increased effectiveness of therapy, a viral load decrease and improving the quality of life of patients.The single-table formulation of dolutegravir with abacavir and lamivudine (DTG/ABC/3TC) is a highly efficacious and well -tolerated once-daily re-gimen for HIV-infected patients. The objective of the study was to assess the incremental cost-utility ratio of the fixed-dose combination of (DTG/ ABC/3TC) versus the combinations emtricitabine/tenofovir/efavirenz (FTC/TDF/EFV), and darunavir/r (DRV/r) or raltegravir (RAL) with emtrici-tabine/tenofovir (FTC/TDF) or abacavir/lamivudine (ABC/3TC) as initial antiretroviral therapy in patients infected with HIV-1 from the perspective of the Spanish National Health System.Method: The ARAMIS model, which uses a microsimulation approach to simulate the individual changes in each patient from the start of treatment to death through a Markov chain of descriptive health states of the disease, was adapted to Spain. The alternatives used for comparison were the fixed- dose combination of emtricitabine/tenofovir/efavirenz (FTC/TDF/ EFV), and the fixed-dose combinations of emtricitabine/tenofovir (FTC/ TDF) or abacavir/lamivudine (ABC/3TC) with darunavir/r (DRV/r) or ral-tegravir (RAL). The probability of achieving virological suppression by the treatments included in the model was obtained from clinical trials SINGLE, SPRING-2 and FLAMINGO and the costs were expressed in € (2015). The model use the perspective of the Spanish National Health System, with a lifetime horizon and a discount rate of 3% was applied to cost and effectiveness.Results: Treatment initiation with DTG/ABC/3TC was dominant when it was compared with treatment initiation with all the comparators: vs. FTC/TDF/EFV (-67 210.71€/QALY), vs. DRV/r + FTC/TDF or ABC/3TC (-1 787 341.44€/QALY), and vs. RAL + FTC/TDF or ABC/3TC (-1 005 117.13€/QALY). All the sensitivity analyses performed showed the consistency of these findings.Conclusions: With the premises considered, treatment initiation with DTG/ABC/3TC STR appears to be the most cost-effective option in ART-naïve HIV infected patients from the Spanish Health System perspective. 2017 artículo científico 1130-6343 https://www.redalyc.org/articulo.oa?id=365962297005 https://www.redalyc.org/journal/3659/365962297005/ https://www.redalyc.org/journal/3659/365962297005/html/ https://www.redalyc.org/journal/3659/365962297005/365962297005.epub https://www.redalyc.org/journal/3659/365962297005/movil 10.7399/fh.10808 en http://www.redalyc.org/revista.oa?id=3659 Farmacia Hospitalaria application/pdf Sociedad Española de Farmacia Hospitalaria Farmacia Hospitalaria (España) Num.5 Vol.41 |
| format | Artículo científico |
| id | redalyc_365962297005 |
| institution | Redalyc |
| language | en |
| publishDate | 2017 |
| publisher | Sociedad Española de Farmacia Hospitalaria |
| spellingShingle | Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain Santiago Moreno Guillén Medicina Cost HIV treatment Utility analysis Computer simulation Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain Santiago Moreno Guillén Juan Emilio Losa García Juan Berenguer Berenguer José Manuel Martínez Sesmero Santiago Cenoz Gomis Ruth Graefehain David López Sánchez-Cambronero Francisco Javier Parrondo García Medicina Cost HIV treatment Utility analysis Computer simulation Objective: Fixed-dose combinations of antiretroviral drugs have meant an important step forward in simplifying treatment and improving com-pliance and has led to an increased effectiveness of therapy, a viral load decrease and improving the quality of life of patients.The single-table formulation of dolutegravir with abacavir and lamivudine (DTG/ABC/3TC) is a highly efficacious and well -tolerated once-daily re-gimen for HIV-infected patients. The objective of the study was to assess the incremental cost-utility ratio of the fixed-dose combination of (DTG/ ABC/3TC) versus the combinations emtricitabine/tenofovir/efavirenz (FTC/TDF/EFV), and darunavir/r (DRV/r) or raltegravir (RAL) with emtrici-tabine/tenofovir (FTC/TDF) or abacavir/lamivudine (ABC/3TC) as initial antiretroviral therapy in patients infected with HIV-1 from the perspective of the Spanish National Health System.Method: The ARAMIS model, which uses a microsimulation approach to simulate the individual changes in each patient from the start of treatment to death through a Markov chain of descriptive health states of the disease, was adapted to Spain. The alternatives used for comparison were the fixed- dose combination of emtricitabine/tenofovir/efavirenz (FTC/TDF/ EFV), and the fixed-dose combinations of emtricitabine/tenofovir (FTC/ TDF) or abacavir/lamivudine (ABC/3TC) with darunavir/r (DRV/r) or ral-tegravir (RAL). The probability of achieving virological suppression by the treatments included in the model was obtained from clinical trials SINGLE, SPRING-2 and FLAMINGO and the costs were expressed in € (2015). The model use the perspective of the Spanish National Health System, with a lifetime horizon and a discount rate of 3% was applied to cost and effectiveness.Results: Treatment initiation with DTG/ABC/3TC was dominant when it was compared with treatment initiation with all the comparators: vs. FTC/TDF/EFV (-67 210.71€/QALY), vs. DRV/r + FTC/TDF or ABC/3TC (-1 787 341.44€/QALY), and vs. RAL + FTC/TDF or ABC/3TC (-1 005 117.13€/QALY). All the sensitivity analyses performed showed the consistency of these findings.Conclusions: With the premises considered, treatment initiation with DTG/ABC/3TC STR appears to be the most cost-effective option in ART-naïve HIV infected patients from the Spanish Health System perspective. 2017 artículo científico 1130-6343 https://www.redalyc.org/articulo.oa?id=365962297005 https://www.redalyc.org/journal/3659/365962297005/ https://www.redalyc.org/journal/3659/365962297005/html/ https://www.redalyc.org/journal/3659/365962297005/365962297005.epub https://www.redalyc.org/journal/3659/365962297005/movil 10.7399/fh.10808 en http://www.redalyc.org/revista.oa?id=3659 Farmacia Hospitalaria application/pdf Sociedad Española de Farmacia Hospitalaria Farmacia Hospitalaria (España) Num.5 Vol.41 |
| title | Cost-utility analysis of the fixed-dose combination of dolutegravir/abacavir/lamivudine as initial treatment of HIV+ patients in Spain |
| topic | Medicina Cost HIV treatment Utility analysis Computer simulation |
| url | https://www.redalyc.org/articulo.oa?id=365962297005 https://www.redalyc.org/journal/3659/365962297005/ https://www.redalyc.org/journal/3659/365962297005/html/ https://www.redalyc.org/journal/3659/365962297005/365962297005.epub https://www.redalyc.org/journal/3659/365962297005/movil |