title: Costs to achieve undetectable HIV RNA with darunavir-containing highly active antiretroviral therapy in highly pretreated patients: the POWER experience.
abstract: BACKGROUND
  Very few studies have evaluated the cost of highly active antiretroviral therapy (HAART) per successful treatment in HIV-infected patients.
  
  
  OBJECTIVE
  To evaluate the cost of achieving undetectable plasma HIV-RNA levels in highly treatment-experienced, HIV-1-infected adults receiving darunavir/ritonavir (DRV/r 600 mg/100 mg twice a day) or control protease inhibitor (PI)-based HAART.
  
  
  METHODS
  The mean annual per-patient cost of DRV/r and control PI-based HAART was determined from the proportional use of antiretroviral agents in the DRV/r and control PI arms of the pooled POWER 1 and 2 trials, applying drug acquisition costs for 13 healthcare settings. The mean annual cost per patient of achieving undetectable plasma HIV-RNA levels (<50 copies/mL) was calculated by dividing the cost of each treatment by the proportion of patients with undetectable plasma HIV-RNA levels after 48 weeks in the DRV/r (45%) and control PI (10%) arms of the POWER trials.
  
  
  RESULTS
  Whereas absolute costs of treatment were 1-19% higher with DRV/r versus control PI-based HAART depending on the healthcare setting, the mean annual per-patient cost of achieving undetectable plasma HIV-RNA levels was 73-78% lower. These cost savings were maintained in the sensitivity analyses, adjusting for control PI and enfuvirtide use, and the number of active drugs in the background regimen. The incremental annual cost per additional patient achieving undetectable plasma HIV-RNA levels with DRV/r versus control PI-based HAART in POWER 1 and 2 (£4148) compared favourably with that determined for enfuvirtide (£137, 740; TORO trials) and tipranavir/ritonavir (£32,176; RESIST) versus control therapy.
  
  
  CONCLUSIONS
  DRV/r-based HAART provided consistent reductions in the cost of achieving undetectable plasma HIV-RNA levels compared with control PI-based therapy in highly treatment-experienced patients across various healthcare settings. The incremental cost per additional patient achieving undetectable plasma HIV-RNA levels with DRV/r versus control PI-based HAART was also lower than that calculated for other treatment options in this population. These results suggest that DRV/r is an economically viable option for highly treatment-experienced patients.
authors.affiliation: Department of Pharmacology University of Liverpool, Liverpool, UK.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Hill
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Matthias
authors.initials: M
authors.lastname: Stoll
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bellos
authors.forename: Erik
authors.initials: E
authors.lastname: Smets
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D000069454:Darunavir; D016527:Drug Costs; D005060:Europe; 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; D011480:Protease Inhibitors / Q000191:economics / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000191:economics / Q000627:therapeutic use; D019438:Ritonavir / Q000191:economics / Q000627:therapeutic use; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use; D019562:Viral Load / Q000191:economics
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D011480:Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D013449:Sulfonamides; D019438:Ritonavir; D000069454:Darunavir