triple antiretroviral therapy very cost effective in hiv infection

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Inpharma 1280 - 24 Mar 2001 Triple antiretroviral therapy very cost effective in HIV infection Treatment of HIV infection with 3-drug antiretroviral therapy is ‘highly cost effective and should be made available to all the patients who can benefit from it’, say US-based researchers. These comments are based on the modelled costs and outcomes associated with a 3-drug regimen of combination antiretroviral therapy vs no therapy in a population of 1 million hypothetical patients with HIV infection. In a base-case analysis using data from the AIDS Clinical Trials Group 320 Study, 3-drug therapy increased projected quality-adjusted life expectancy by 2.9 quality-adjusted life-years (QALYs) at a lifetime discounted cost of $US77 300, and an incremental cost per QALY gained of $US23 000, compared with no therapy. * Because patients in the AIDS Clinical Trials Group 320 Study had advanced disease, the researchers also performed analyses using data from other large trials; ** these analyses found cost-effectiveness ratios of $US13 000–$US17 000 per QALY gained for 3-drug antiretroviral therapy. Cost effectiveness sensitive to drug costs The researchers found that life expectancy and total lifetime costs were sensitive to CD4+ cell count at presentation. Initiating therapy at a CD4+ cell count of 500/mm 3 was ‘more effective and a more efficient use of resources’ than starting therapy at a lower cell count (200–350/mm 3 ). Cost effectiveness was also sensitive to the cost, but not the efficacy, of antiretroviral drugs. A 50% reduction in the cost of antiretroviral drugs reduced per-patient lifetime costs to $US67 620 and the cost- effectiveness ratio to $US16 000/QALY gained, compared with no therapy. Modelled costs were relatively robust across a range of assumptions relating to opportunistic infections and chronic adverse effects. * Costs (1998 values) comprised the direct costs of acute and routine medical care for patients with HIV infection. ** the Johns Hopkins HIV Clinic cohort study; the Italy, the Netherlands, Canada, and Australia (INCAS) trial; and the Dupont 006 trial Freedberg KA, et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. New England Journal of Medicine 344: 824-831, 15 Mar 2001 800852856 1 Inpharma 24 Mar 2001 No. 1280 1173-8324/10/1280-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Page 1: Triple antiretroviral therapy very cost effective in HIV infection

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