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, Marwân-al-Qays Bousmah (), R. Toby, M. P. Mpoudi-Etame, N. F. Ngom Gueye, A. Sawadogo, C. Kouanfack, L. Ciaffi, B. Spire and E. Delaporte
Additional contact information
S. Boyer: Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale
M. L. Nishimwe: Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale
L. Sagaon-Teyssier: Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale
L. March: University of Montpellier
S. Koulla-Shiro: Yaoundé Central Hospital
R. Toby: Central Hospital
M. P. Mpoudi-Etame: Region 1 Military Hospital
N. F. Ngom Gueye: Fann Hospital
A. Sawadogo: University Hospital Souro Sanou
C. Kouanfack: Yaoundé Central Hospital
L. Ciaffi: University of Montpellier
B. Spire: Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale
E. Delaporte: University of Montpellier

PharmacoEconomics - Open, 2020, vol. 4, issue 1, No 6, 45-60

Abstract: 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.

Date: 2020
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DOI: 10.1007/s41669-019-0157-9

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