title: Cost-effectiveness of atazanavir/ritonavir compared with lopinavir/ritonavir in treatment-naïve human immunodeficiency virus-1 patients in Sweden.
abstract: OBJECTIVE
  The aim of this study was to estimate the cost-effectiveness of atazanavir/ritonavir (atazanavir/r) versus lopinavir/ritonavir (lopinavir/r) in treatment-naïve human immunodeficiency virus-1 (HIV-1) patients in Sweden for whom efavirenz is not suitable.
  
  
  METHODS
  A Markov model was developed to predict the lifetime outcomes of atazanavir/r and lopinavir/r in terms of quality-adjusted life years (QALYs) and total costs. The model was structured to focus on treatment lines--how patients progress from first- to second-, and then to third-line treatment. Model inputs were derived directly from clinical trials, such as the CASTLE study (a 96-week head-to-head trial in first-line therapy), and from the Framingham risk-equation. The analysis was conducted from a payer perspective and included extensive scenario and probabilistic sensitivity analyses.
  
  
  RESULTS
  The model predicted atazanavir/r to save 0.16 (95% confidence interval (CI) 0.00 to 0.33) QALYs and reduce total costs by -202,896 SEK (95% CI -332,156 to -81,644 SEK) over a lifetime horizon. Probabilistic sensitivity analyses showed that atazanavir/r had a 100% probability to be cost-effective at a willingness to pay of 200,000 SEK per QALY.
  
  
  CONCLUSIONS
  The results indicate that atazanavir/r is cost-saving and more effective compared to lopinavir/r for patients who have previously not been exposed to antiretroviral drugs in Sweden.
authors.affiliation: Pharmerit BV, Rotterdam, Netherlands. pthuresson@pharmerit.com
authors.forename: Per-Olof
authors.initials: PO
authors.lastname: Thuresson
authors.forename: Bart
authors.initials: B
authors.lastname: Heeg
authors.forename: Benedicte
authors.initials: B
authors.lastname: Lescrauwaet
authors.forename: Karin
authors.initials: K
authors.lastname: Sennfält
authors.forename: Annette
authors.initials: A
authors.lastname: Alaeus
authors.forename: Aljoscha
authors.initials: A
authors.lastname: Neubauer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000379:methods*; D000069446:Atazanavir Sulfate; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D061466:Lopinavir; D015233:Models, Statistical; D009842:Oligopeptides / Q000008:administration & dosage* / Q000191:economics; D011725:Pyridines / Q000008:administration & dosage* / Q000191:economics; D011744:Pyrimidinones / Q000008:administration & dosage* / Q000191:economics; D019057:Quality-Adjusted Life Years; D019438:Ritonavir / Q000008:administration & dosage* / Q000191:economics; D013548:Sweden
chemical_list: D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D011744:Pyrimidinones; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D019438:Ritonavir