Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa

S Boyer, M L Nishimwe, L Sagaon-Teyssier, L March, S Koulla-Shiro, M-Q Bousmah, R Toby, M P Mpoudi-Etame, N F Ngom Gueye, A Sawadogo, C Kouanfack, L Ciaffi, B Spire, E Delaporte, 2-Lady Group, E Delaporte, S Koulla-Shiro, C T Ndour, A Sawadogo, V Le Moing, J Reynes, A Calmy, L Ciaffi, P M Girard, S Eholie, M L Chaix, C Kouanfack, I Tita, B Bazin, P Garcia, J B Guiard-Schmid, S Izard, S Eymard-Duvernay, M Peeters, L Serrano, A Cournil, I Diallo, J M Mben, R Toby, N Manga, L Ayangma, B Taman, F N Kabore, E Kamboule, J Zoungrana, A Diouf, M Diallo, L Fortes, N F Ngom Gueye, G Batista, A Aghokeng, E Guichet, H Abessolo, C Essomba, G Manirakiza, F Essomba, T Mbarga, S Epanda, A Bikie, T Nke, N Massaha, E Nke, M Ngolle, D Bikobo, L Abologo, O Elat, G Laborde-Balen, A Diop, B Diouf, N Bara, M B Koita Fall, C Toure Kane, F B Seck, S Ba, P Njantou, A Ndyaye, A Hema, P Fao, P Ouedrago, R Traore, Y Sanou, G Bado, M Coulibaly, E Some, J Some, A Kambou, A Tapsoba, D Sombie, S Sanou, B Traore, P Flandre, C Michon, J Drabo, F Simon, S Boyer, M L Nishimwe, L Sagaon-Teyssier, L March, S Koulla-Shiro, M-Q Bousmah, R Toby, M P Mpoudi-Etame, N F Ngom Gueye, A Sawadogo, C Kouanfack, L Ciaffi, B Spire, E Delaporte, 2-Lady Group, E Delaporte, S Koulla-Shiro, C T Ndour, A Sawadogo, V Le Moing, J Reynes, A Calmy, L Ciaffi, P M Girard, S Eholie, M L Chaix, C Kouanfack, I Tita, B Bazin, P Garcia, J B Guiard-Schmid, S Izard, S Eymard-Duvernay, M Peeters, L Serrano, A Cournil, I Diallo, J M Mben, R Toby, N Manga, L Ayangma, B Taman, F N Kabore, E Kamboule, J Zoungrana, A Diouf, M Diallo, L Fortes, N F Ngom Gueye, G Batista, A Aghokeng, E Guichet, H Abessolo, C Essomba, G Manirakiza, F Essomba, T Mbarga, S Epanda, A Bikie, T Nke, N Massaha, E Nke, M Ngolle, D Bikobo, L Abologo, O Elat, G Laborde-Balen, A Diop, B Diouf, N Bara, M B Koita Fall, C Toure Kane, F B Seck, S Ba, P Njantou, A Ndyaye, A Hema, P Fao, P Ouedrago, R Traore, Y Sanou, G Bado, M Coulibaly, E Some, J Some, A Kambou, A Tapsoba, D Sombie, S Sanou, B Traore, P Flandre, C Michon, J Drabo, F Simon

Abstract

Background: While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle-income countries. We assessed the cost-effectiveness of three alternative bPI-based second-line regimens in Burkina Faso, Cameroon and Senegal.

Methods: We used data collected over 2010-2015 in the 2LADY trial/post-trial cohort. Patients with first-line antiretroviral therapy (ART) failure were randomly assigned to tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r; arm A), abacavir + didanosine + lopinavir/ritonavir (arm B), or tenofovir/emtricitabine + darunavir/ritonavir (arm C). Costs (US dollars, 2016), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were computed for each country over 24 months of follow-up and extrapolated to 5 years using a simulated patient-level Markov model. We assessed uncertainty using cost-effectiveness acceptability curves, scenarios and prices threshold analysis.

Results: In each country, over 24 months, arm A was significantly less costly than arms B and C (incremental costs ranging from US$410-$US721 and US$468-US$546 for B and C vs A, respectively) and offered similar health benefits (incremental QALY: - 0.138 to 0.023 and - 0.179 to 0.028, respectively). Over 5 years, arm A remained the least costly, health benefits not being significantly different between arms. Compared with arms B and C, in each study country, Arm A had a ≥ 95% probability of being cost-effective for a large range of cost-effectiveness thresholds, irrespective of the scenario considered.

Conclusions: Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries.

Trial registration: ClinicalTrials.gov Identifier: NCT00928187.

Conflict of interest statement

L.C, S.K-S and A.S report grants from ANRS with financial support by Janssen Pharmaceuticals. E.D, C.K, R.T, N.F.N.G, S.B, L.M, M.L.N, L.S-T, M.A.B, M.P.M-E and B.S report no conflict of interest in relation to this study.

Figures

Fig. 1
Fig. 1
Cost-effectiveness acceptability curves of TDF/FTC LPV/r compared with ABC ddI LPV/r (a) and compared with TDF/FTC DRV/r (b) in the ANRS 12169 2LADY trial. The coloured vertical lines indicate the cost-effectiveness thresholds of 1 times the GDP/capita in 2016 for each of the three study countries (i.e. US$584 in Burkina Faso, US$1392 in Cameroon and US$1231 in Senegal). The cost-effectiveness acceptability curves show the probability that TDF/FTC LPV/r is cost-effective compared with ABC ddI LPV/r (a) and with TDF/FTC DRV/r (b) in each of the three study countries over a range of values for the cost-effectiveness threshold λ (i.e. the maximum amount that the decision maker is willing to pay for one unit of health). ABC ddI LPV/r abacavir + didanosine + lopinavir/ritonavir, Prob(TDF/FTC LPV/r CE) probability of TDF/FTC LPV/r being cost-effective at one times the country’s per-capita gross domestic product, QALYs quality-adjusted life-years, TDF/FTC DRV/r tenofovir/emtricitabine + darunavir/ritonavir, TDF/FTC LPV/r tenofovir/emtricitabine + lopinavir/ritonavir

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Source: PubMed

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