Cost to achieve an undetectable viral load using recommended antiretroviral regimens.
OBJECTIVE
The April 2005 Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents recommended 9 regimens to be combined with 2 nucleoside reverse transcriptase inhibitors (NRTIs). These regimens are effective in lowering viral load but are expensive. This study aimed to determine the cost for each regimen to achieve an undetectable viral load.


METHODS
52 clinical trials were reviewed. The outcome measure was cost per undetectable patient, C/PU, where C = cost of a drug, and PU = percent of patients with undetectable viral loads.


RESULTS
For 30 weeks, cost per undetectable (<400 copies/mL) ranged from 4,416 dollars (efavirenz) to 23,110 dollars (nelfinavir); for 42 weeks, the range was 5,729 dollars (efavirenz) to 24,071 dollars (indinavir/ritonavir); for 60 weeks, it ranged from 9,535 dollars (efavirenz) to 26,829 dollars (fosamprenavir); and for 84 weeks, it ranged from 12,203 dollars (efavirenz) to 22,960 dollars (nelfinavir). For <50 copies/mL, at 30 weeks the range was from 7,140 dollars (efavirenz) to 17,548 dollars (atazanavir); for 42 weeks, it ranged from 9,849 dollars (lopinavir/ritonavir) to 13,181 dollars (nelfinavir); for 60 weeks, it ranged from 8,702 dollars (nevirapine) to 36,034 dollars (atazanavir); and for 84 weeks, it ranged from 15,660 dollars (efavirenz) to 29,177 dollars (indinavir/ritonavir).


CONCLUSIONS
Efavirenz's low price and high effectiveness make it the least expensive means of achieving an undetectable viral load.
Basu
Rituparna P
RP
The University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas 77225-0816, USA.
Grimes
Richard M
RM
Helmy
Amgad F
AF
D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000276:immunology; D006801:Humans; D018894:Reverse Transcriptase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019562:Viral Load / Q000191:economics* / Q000706:statistics & numerical data
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D018894:Reverse Transcriptase Inhibitors