• 作者：Antonio Javier Blasco ; Jos¨¦ Ram¨®n Arribas ; Vicente Boix ; Bonaventura Clotet ; Pere Domingo ; Juan Gonz¨¢lez-Garc¨ªa ; Hern ; o Knobel ; Juan Carlos L¨®pez ; Josep M. Llibre ; Fern ; o Lozano ; Jos¨¦ M. Mir¨® ; Daniel Podzamczer ; Juan Miguel Santamar¨ªa ; Montserrat Tuset ; Laura Zamora ; Pablo L¨¢zaro ; Josep M. Gatell ; en representaci¨®n de GESIDA
• 关键词：Costes ; Eficacia ; Eficiencia ; Virus de la inmunodeficiencia humana (VIH) ; Sida ; Tratamiento ; Antirretrovirales
• 刊名：Enfermedades Infecciosas y Microbiolog¨ªa Cl¨ªnica
• 出版年：2012
• 出版时间：June-July, 2012
• 年：2012
• 卷：30
• 期：6
• 页码：283-293
• 全文大小：289 K

Introduction

The GESIDA and National AIDS Plan panel of experts propose ?preferred regimens? of antiretroviral treatment (ART) as initial therapy in HIV infected patients for 2012. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these ?preferred regimens?.

Methods

Economic assessment of costs and efficiency (cost/efficacy) using decision tree analysis model. Efficacy was defined as the probability of having a viral load <50 copies/ml at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and all its consequences (adverse effects, changes of ART regime, and drug resistance analyses) during the first 48 weeks. The perspective of the analysis is that of the National Health System, considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance and determination of HLA B*5701. The setting is Spain and the costs are those of 2012. A sensitivity deterministic analysis was conducted, building three scenarios for each regime: baseline, most favourable, and most unfavourable cases.

Results

In the baseline case scenario, the cost of initiating treatment ranges from 6,895 euros for TDF/FTC + NVP to 12,067 euros for TDF/FTC + RAL. The efficacy ranges between 0.66 for ABC/3TC + LPV/r and 0.87 for TDF/FTC + RAL. Efficiency, in terms of cost/efficacy, varies between 9,387 and 13,823 euros per responder at 48 weeks, for TDF/FTC/EFV and TDF/FTC + RAL, respectively. In the most unfavourable scenario, the most efficient regime is TDF/FTC + NVP (9,742 per responder).

Conclusion

Considering the official prices of ART, the most efficient regimens are TDF/FTC/EFV (baseline case and most favourable scenarios), and TDF/FTC + NVP (most unfavourable scenario).