Cost-Utility Analysis of a Dolutegravir-Based Versus Low-Dose Efavirenz-Based Regimen for the Initial Treatment of HIV-Infected Patients in Cameroon (NAMSAL ANRS 12313 Trial)
Marwân-Al-Qays Bousmah, Marie Libérée Nishimwe, Tamara Tovar-Sanchez, Martial Lantche Wandji, Mireille Mpoudi-Etame, Gwenaëlle Maradan, Pierrette Omgba Bassega, Marie Varloteaux, Alice Montoyo, Charles Kouanfack, Eric Delaporte, Sylvie Boyer, New Antiretroviral and Monitoring Strategies in HIV-infected Adults in Low-Income Countries (NAMSAL) ANRS 12313 Study Group, A Ayouba, A Agholeng, C Butel, A Cournil, E Delaporte, S Eymard-Duvernay, B Granouillac, S Izard, A Lacroix, S Leroy, M Peeters, S Perrineau, L Serrano, J Reynes, T Tovar-Sanchez, N Vidal, P J Fouda, C Kounfack, R Mougnoutou, J Olinga, V Omgba, S C Tchokonte Ngandé, B Ymele, A Kambi, C D Epoupa Mpacko, M Mpoudi-Etame, M Fotso, R Moukoko, T Nké, A Akamba, S Lekelem, P Omgba Bassega, S B Tongo Fotack, S Ngono, M Tanga, E Ebong, G Edoul Mbesse, M Tsongo, E Mpoudi-Ngolé, T Abong, L Ciaffi, S Koulla-Shiro, M Lantché Wandji, G Manirakiza, E D Mimbé, D Tetsa Tata, M Varloteaux, S Boyer, M-Q Bousmah, G Maradan, M L Nishimwe, B Spire, M P Lê, G Peytavin, A Diallo, I Fournier, A Montoyo, N Mercier, C Rekacewicz, C Perez Casa, C Charpentier, N Clumeck, P Flandre, F Ngom Gueye, L Weiss, A Calmy, C Kouanfack, A Hill, J Reynes, E Delaporte, Marwân-Al-Qays Bousmah, Marie Libérée Nishimwe, Tamara Tovar-Sanchez, Martial Lantche Wandji, Mireille Mpoudi-Etame, Gwenaëlle Maradan, Pierrette Omgba Bassega, Marie Varloteaux, Alice Montoyo, Charles Kouanfack, Eric Delaporte, Sylvie Boyer, New Antiretroviral and Monitoring Strategies in HIV-infected Adults in Low-Income Countries (NAMSAL) ANRS 12313 Study Group, A Ayouba, A Agholeng, C Butel, A Cournil, E Delaporte, S Eymard-Duvernay, B Granouillac, S Izard, A Lacroix, S Leroy, M Peeters, S Perrineau, L Serrano, J Reynes, T Tovar-Sanchez, N Vidal, P J Fouda, C Kounfack, R Mougnoutou, J Olinga, V Omgba, S C Tchokonte Ngandé, B Ymele, A Kambi, C D Epoupa Mpacko, M Mpoudi-Etame, M Fotso, R Moukoko, T Nké, A Akamba, S Lekelem, P Omgba Bassega, S B Tongo Fotack, S Ngono, M Tanga, E Ebong, G Edoul Mbesse, M Tsongo, E Mpoudi-Ngolé, T Abong, L Ciaffi, S Koulla-Shiro, M Lantché Wandji, G Manirakiza, E D Mimbé, D Tetsa Tata, M Varloteaux, S Boyer, M-Q Bousmah, G Maradan, M L Nishimwe, B Spire, M P Lê, G Peytavin, A Diallo, I Fournier, A Montoyo, N Mercier, C Rekacewicz, C Perez Casa, C Charpentier, N Clumeck, P Flandre, F Ngom Gueye, L Weiss, A Calmy, C Kouanfack, A Hill, J Reynes, E Delaporte
Abstract
Objectives: Evidence comparing the economic and patient values of the World Health Organization's preferred (dolutegravir 50 mg [DTG]-based) and alternative (low-dose [400 mg] efavirenz [EFV400]-based) first-line antiretroviral regimens is limited. We compared patient-reported outcomes (PROs), costs, and the cost-utility of DTG- versus EFV400-based regimens in treatment-naive HIV-1 adults in the randomised NAMSAL ANRS 12313 trial in Yaoundé, Cameroon.
Methods: We used clinical data, PROs, and health resource use data collected in the trial's first 96 weeks (2016-2019). Quality-adjusted life-years (QALYs) were computed using utility scores obtained from the 12-item Short Form (SF-12) generic health scale. Other PROs included perceived symptoms, depression, anxiety, and stress. In the 96-week base-case analysis, we estimated the unadjusted and multivariate-adjusted (1) mean costs (in US$, 2016 values) and QALYs/patient, (2) incremental costs and QALYs/patient, and (3) net health benefit (NHB). Outcomes were extrapolated over 5 and 10 years. Uncertainty was assessed using the cost-effectiveness acceptability curve and scenario and cost-effective price threshold analyses.
Results: In the base-case analysis, the NHB (95% confidence interval) for the DTG-based regimen relative to the EFV400-based regimen was 0.056 (- 0.037 to 0.153), corresponding to an 88% probability of DTG being cost-effective. A 10% decrease in this regimen's price (from $5.2 to $4.7/month) would increase its cost-effectiveness probability to 95%. When extrapolating outcomes over 5 and 10 years, the DTG-based regimen had a 100% probability of being cost-effective for a large range of cost-effectiveness thresholds.
Conclusions: At 2020 antiretroviral drug prices, a DTG-based first-line regimen should be preferred over an EFV400-based regimen in sub-Saharan Africa.
Trial registration: ClinicalTrials.gov Identifier: NCT02777229.
Conflict of interest statement
All authors report no conflict of interest in relation to this study.
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