triple antiretroviral therapy very cost effective in hiv infection
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Inpharma 1280 - 24 Mar 2001
Triple antiretroviral therapy verycost effective in HIV infection
Treatment of HIV infection with 3-drug antiretroviraltherapy is ‘highly cost effective and should be madeavailable to all the patients who can benefit from it’, sayUS-based researchers.
These comments are based on the modelled costs andoutcomes associated with a 3-drug regimen ofcombination antiretroviral therapy vs no therapy in apopulation of 1 million hypothetical patients with HIVinfection.
In a base-case analysis using data from the AIDSClinical Trials Group 320 Study, 3-drug therapyincreased projected quality-adjusted life expectancy by2.9 quality-adjusted life-years (QALYs) at a lifetimediscounted cost of $US77 300, and an incremental costper QALY gained of $US23 000, compared with notherapy.* Because patients in the AIDS Clinical TrialsGroup 320 Study had advanced disease, the researchersalso performed analyses using data from other largetrials;** these analyses found cost-effectiveness ratios of$US13 000–$US17 000 per QALY gained for 3-drugantiretroviral therapy.
Cost effectiveness sensitive to drug costsThe researchers found that life expectancy and total
lifetime costs were sensitive to CD4+ cell count atpresentation. Initiating therapy at a CD4+ cell count of500/mm3 was ‘more effective and a more efficient use ofresources’ than starting therapy at a lower cell count(200–350/mm3). Cost effectiveness was also sensitive tothe cost, but not the efficacy, of antiretroviral drugs. A50% reduction in the cost of antiretroviral drugs reducedper-patient lifetime costs to $US67 620 and the cost-effectiveness ratio to $US16 000/QALY gained,compared with no therapy. Modelled costs wererelatively robust across a range of assumptions relatingto opportunistic infections and chronic adverse effects.* Costs (1998 values) comprised the direct costs of acute and routinemedical care for patients with HIV infection.** the Johns Hopkins HIV Clinic cohort study; the Italy, theNetherlands, Canada, and Australia (INCAS) trial; and the Dupont 006trial
Freedberg KA, et al. The cost effectiveness of combination antiretroviral therapyfor HIV disease. New England Journal of Medicine 344: 824-831, 15 Mar2001 800852856
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Inpharma 24 Mar 2001 No. 12801173-8324/10/1280-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved