Economic analysis of initial HIV treatment. Efavirenz- versus indinavir-containing triple therapy.
OBJECTIVE
To compare the clinical and economic outcomes associated with triple therapy containing efavirenz or indinavir and 2 nucleoside reverse transcriptase inhibitors (NRTIs; zidovudine and lamivudine) in HIV-positive patients.


METHODS
An economic model based on viral load and CD4+ cell counts to predict long term outcomes such as progression to AIDS and AIDS-related death was developed and then analysed using data from a randomised clinical trial. Cost estimates from the healthcare system perspective were based on data from 6 state, all-payor databases, the AIDS Cost and Services Utilisation Study, and other literature. Analyses were carried out for time horizons between 5 and 15 years.


METHODS
HIV-positive patients with limited exposure to NRTIs. Initial regimens consisted of efavirenz or indinavir, each combined with 2 NRTIs. A maximum of 2 switches to other regimens was permitted.


RESULTS
The efavirenz-containing triple therapy regimen was predicted to prolong survival at a savings of up to 10,923 US dollars (1998 values) relative to initial therapy with the indinavir-containing regimen. Patients who receive efavirenz are expected to have 11% greater survival at 5 years and fewer treatment failures (28 vs 52%, at 2 years). Overall, the economic and health benefits predicted for the efavirenz-containing regimen were robust to reasonable variation in key parameters.


CONCLUSIONS
The superior clinical trial outcomes for efavirenz-containing regimens should translate into substantial economic and health benefits.
Caro
J J
JJ
Caro Research, Concord, Massachusetts, USA. jcaro@caroresearch.com
O'Brien
J A
JA
Migliaccio-Walle
K
K
Raggio
G
G
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000480:Alkynes; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D048588:Benzoxazines; D003521:Cyclopropanes; D018450:Disease Progression; D016527:Drug Costs; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D017320:HIV Protease Inhibitors / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D019469:Indinavir / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D010078:Oxazines / Q000191:economics* / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000191:economics / Q000627:therapeutic use
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D010078:Oxazines; D018894:Reverse Transcriptase Inhibitors; D019469:Indinavir; C098320:efavirenz