title: Cost-effectiveness of optimized background therapy plus maraviroc for previously treated patients with R5 HIV-1 infection from the perspective of the Spanish health care system.
abstract: OBJECTIVE
  The aim of this work was to evaluate the cost-effectiveness, from the perspective of the Spanish health care system, of optimized background therapy (OBT) plus maraviroc 300 mg BID versus OBT plus placebo in previously treated patients with R5 HIV-1 infection.
  
  
  METHODS
  A lifetime cohort model was developed, based on 24- and 48-week pooled results from the Maraviroc Versus Optimized Therapy in Viremic Antiretroviral Treatment-Experienced Patients (MOTIVATE) studies 1 and 2, to reflect the Spanish health care system's perspective. Treatment duration was based on clinical trial follow-up from MOTIVATE 1 and 2. Clinical data, cohort characteristics, success probability, CD4 increase rate, CD4 cell status link to disease states, and adverse-event probability were taken from the MOTIVATE trials and other published literature. Other input parameters were taken from published sources. Antiretroviral (ARV) costs were derived from local sources. Non-ARV drug costs were obtained from published literature and a cost database. All costs were calculated as year-2009 euros. The annual discount rate was set at 3.0%. The main outcomes were cost per life-year gained (LYG) and cost per quality-adjusted life-year (QALY) gained. Uncertainty was assessed with one-way and probabilistic sensitivity analyses.
  
  
  RESULTS
  In the model analysis, adding maraviroc to OBT was associated with an increase of 0.952 LYG and 0.909 QALY. Total costs were €275,970 for maraviroc plus OBT and €254,655 for placebo plus OBT (difference: €21,315). The incremental cost per LYG was €22,398 and the incremental cost per QALY gained was €23,457. The model appeared to be robust for variations in key parameters. Results from the probabilistic sensitivity analyses indicated that the probability of the cost per QALY being below €30,000 was 99%.
  
  
  CONCLUSIONS
  Despite the limitations of the model, our analysis suggested that OBT plus maraviroc 300 mg BID is a clinically valuable option, and cost-effective from the perspective of the Spanish health care system, for previously treated patients with R5 HIV-1 infection.
authors.affiliation: Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
authors.forename: Juan
authors.initials: J
authors.lastname: González
authors.forename: Ingrid
authors.initials: I
authors.lastname: Lekander
authors.forename: Belén
authors.initials: B
authors.lastname: Martí
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
authors.forename: Rainel
authors.initials: R
authors.lastname: Sánchez-de la Rosa
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Casado
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D065100:CCR5 Receptor Antagonists; D003362:Cost-Benefit Analysis; D003510:Cyclohexanes / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D023581:HIV Fusion Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D000077592:Maraviroc; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs; D019057:Quality-Adjusted Life Years; D013030:Spain; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D065100:CCR5 Receptor Antagonists; D003510:Cyclohexanes; D023581:HIV Fusion Inhibitors; D014230:Triazoles; D000077592:Maraviroc