Comparative cost-efficacy analysis of darunavir/ritonavir and other ritonavir-boosted protease inhibitors for first-line treatment of HIV-1 infection in the United States.
OBJECTIVE
A comprehensive study comparing the costs and efficacies of darunavir/ritonavir 800/100 mg qd and the other ritonavir-boosted (/r) protease inhibitors (PIs) recommended for treatment-naïve individuals with HIV-1 infection would help health care decision makers identify the value of each boosted PI.


METHODS
A cost-efficacy model was developed to compare the five recommended boosted PIs, each used with a tenofovir-based nucleotide/nucleoside reverse transcriptase inhibitor backbone. Efficacy was measured by virologic response (ie, HIV-1 ribonucleic acid < 50 copies/mL) at 48 weeks, based on a systematic review and meta-analysis of recent clinical trials. One-year antiretroviral therapy costs and 48-week efficacy values were used to generate the efficiency frontier and cost-efficacy ratios.


RESULTS
Darunavir/r was the most efficacious boosted PI, with an incremental cost-efficacy ratio of $27,390 per additional individual with virologic response, compared with fosamprenavir/r. All other regimens were dominated. Darunavir/r combination therapy also had one of the lowest average costs ($26,287) per individual with virologic response, resulting in a maximal number of individuals successfully treated within a fixed budget. The model results were robust in variability and sensitivity analyses.


CONCLUSIONS
Darunavir/r 800/100 mg qd combination therapy represents a cost-efficacious option for treatment-naïve individuals with HIV-1 infection in the United States.
Brogan
Anita J
AJ
RTI Health Solutions, Research Triangle Park, North Carolina 27709, USA. abrogan@rti.org
Mrus
Joseph
J
Hill
Andrew
A
Sawyer
Anthony W
AW
Smets
Erik
E
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003362:Cost-Benefit Analysis; D000069454:Darunavir; D023381:Endpoint Determination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000821:virology; D017320:HIV Protease Inhibitors / Q000191:economics* / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D008297:Male; D017059:Models, Econometric; D012367:RNA, Viral / Q000097:blood; D019438:Ritonavir / Q000191:economics* / Q000627:therapeutic use; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D013449:Sulfonamides; D019438:Ritonavir; D000069454:Darunavir