Cost-effectiveness of raltegravir in antiretroviral treatment-experienced HIV-1-infected patients in Switzerland.
OBJECTIVE
Raltegravir, a novel integrase inhibitor, has shown great efficacy in reducing HIV viral load among treatment-experienced patients. A cohort state-transition model was used to assess the long-term effect of raltegravir treatment on costs and quality-adjusted life expectancy from a Swiss perspective.


METHODS
Patients were stratified into health states according to opportunistic infection status, HIV RNA level, and CD4 count, with each group assigned a treatment cost and utility (quality of life) score. Model inputs came from published studies, clinical trials, and database analyses. Results were used to calculate incremental cost-effectiveness ratio (ICER) of raltegravir use, expressed in Swiss francs (CHF) as incremental cost/quality-adjusted life-year (QALY) gained. Future costs and QALYs were discounted at 3% per year.


RESULTS
Five years of raltegravir treatment increased discounted quality-adjusted life expectancy by 3.73 years over placebo, with additional discounted cost of CHF 170,347, resulting in an ICER of CHF 45,687/QALY. ICERs ranged from CHF 42,751 to 53,478/QALY for treatment duration of 3 and 10 years, respectively. Results were most sensitive to changes in raltegravir treatment duration, source of estimated quality of life weights, and raltegravir price.


CONCLUSIONS
Adding raltegravir to optimized background therapy was a cost-effective strategy for treatment-experienced patients in Switzerland.
Elbasha
E E
EE
Merck Research Laboratories, North Wales, Pennsylvania, USA.
Szucs
T
T
Chaudhary
M A
MA
Kumar
Ritesh N
RN
Roediger
A
A
Cook
J R
JR
Opravil
M
M
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000821:virology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology / Q000821:virology; D019428:HIV Integrase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D015497:HIV-1 / Q000235:genetics / Q000254:growth & development*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D011760:Pyrrolidinones / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012367:RNA, Viral / Q000097:blood; D000068898:Raltegravir Potassium; D013557:Switzerland
D019428:HIV Integrase Inhibitors; D011760:Pyrrolidinones; D012367:RNA, Viral; D000068898:Raltegravir Potassium