Cost-Effectiveness Analysis of Lopinavir/Ritonavir Monotherapy Versus Standard Combination Antiretroviral Therapy in HIV-1 Infected Patients with Viral Suppression in France (ANRS 140 DREAM)

Osvaldo Ulises Garay, Marie Libérée Nishimwe, Marwân-al-Qays Bousmah (), Asmaa Janah, Pierre-Marie Girard, Geneviève Chêne, Laetitia Moinot, Luis Sagaon-Teyssier, Jean-Luc Meynard, Bruno Spire and Sylvie Boyer ()
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Osvaldo Ulises Garay: Aix Marseille University
Marie Libérée Nishimwe: Aix Marseille University
Asmaa Janah: Aix Marseille University
Pierre-Marie Girard: AP-HP, Hôpital Saint-Antoine
Geneviève Chêne: University of Bordeaux, ISPED
Laetitia Moinot: University of Bordeaux, ISPED
Luis Sagaon-Teyssier: Aix Marseille University
Jean-Luc Meynard: AP-HP, Hôpital Saint-Antoine
Bruno Spire: Aix Marseille University
Sylvie Boyer: Aix Marseille University

PharmacoEconomics - Open, 2019, vol. 3, issue 4, No 8, 505-515

Abstract: Abstract Background Protease inhibitor monotherapy is a simplified treatment strategy for virally suppressed HIV-positive patients that has the potential for cost savings, as fewer drugs are used than with combination therapy. However, evidence for its economic value is limited. Objectives We assessed the cost-effectiveness of lopinavir/ritonavir monotherapy followed by treatment intensification in case of viral load rebound versus combination antiretroviral therapy (cART) with efavirenz/emtricitabine/tenofovir in HIV-1 infected patients with viral suppression in the ANRS 140 DREAM trial. Methods DREAM was conducted in 36 French Hospitals between 2009 and 2013. For each treatment strategy, we estimated the unadjusted and multivariate-adjusted mean costs (in €, year 2010 values) and quality-adjusted life-years (QALYs) per patient, as well as incremental costs and QALYs per patient. We then assessed uncertainty using the cost-effectiveness acceptability curve, scenario analyses and cost-effectiveness price-threshold (CEPT) analysis. Results In the base-case analysis considering 2009–2013 antiretroviral drug (ARV) prices, adjusted incremental costs and QALYs were − €3296 (95% confidence interval [CI] − 5202 to − 1391) and 0.006 (95% CI − 0.021 to 0.033), respectively, over 2 years, suggesting that monotherapy was cost-effective with a probability of 100% at various cost-effectiveness thresholds. In scenario analyses considering 2018 ARV prices, monotherapy remained cost-effective but with a lower probability (94% vs. 100% in the base-case analysis). The current price of cART would have to decrease by 34% to be cost-effective with a probability of 95%. Conclusion Monotherapy appears to be cost-effective compared with cART for virologically suppressed HIV-positive patients in France. CEPT analysis is a useful tool to identify the preferred strategy to adopt given that ARV prices change rapidly. Trial registration Clinicaltrials.gov identifier: NCT00946595.

Date: 2019
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DOI: 10.1007/s41669-019-0130-7

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