title: Cost-effectiveness of combination therapy with etravirine in treatment-experienced adults with HIV-1 infection.
abstract: OBJECTIVE
  To assess the cost-effectiveness of etravirine (INTELENCE), a novel nonnucleoside reverse transcriptase inhibitor, used in combination with a background regimen that included darunavir/ritonavir, from a Canadian Provincial Ministry of Health perspective.
  
  
  METHODS
  A Markov model with a 3-month cycle time and six health states based on CD4 cell count ranges was developed to follow a hypothetical cohort of treatment-experienced adults with HIV-1 infection through initial and subsequent treatment regimens.
  
  
  METHODS
  Costs (in 2009 Canadian dollars), utilities, and HIV-related mortality data for each health state as well as non-HIV-related mortality data were estimated from Canadian sources and published literature. Transition probabilities between health states and first-year hospitalization and mortality rates were derived from clinical trial data. Incremental 1-year costs per additional adult with viral load less than 50 copies/ml at 48 weeks and incremental lifetime costs per quality-adjusted life-year (QALY) gained were estimated using a 5% discount rate. Sensitivity and variability analyses and model validation were performed.
  
  
  RESULTS
  Etravirine was associated with an increased probability of achieving less than 50 copies/ml at 48 weeks of 0.205 and an estimated gain of 0.66 discounted (1.48 undiscounted) QALYs over a lifetime. The incremental 1-year cost per additional person with viral load less than 50 copies/ml was $23,862. The lifetime incremental cost per QALY gained was $49,120. For the uncertainty ranges and variability scenarios tested for the lifetime horizon, the cost-effectiveness ratio was between $28,859 and 66,249.
  
  
  CONCLUSIONS
  When compared with optimized standard of care including darunavir/ritonavir, adding etravirine represents a cost-effective option for treatment-experienced adults in Canada.
authors.affiliation: RTI Health Solutions, Research Triangle Park, North Carolina, USA. jmauskopf@rti.org
authors.forename: Josephine
authors.initials: J
authors.lastname: Mauskopf
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Brogan
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Talbird
authors.forename: Silas
authors.initials: S
authors.lastname: Martin
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D000069454:Darunavir; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009570:Nitriles; D011724:Pyridazines / Q000191:economics* / Q000627:therapeutic use; D011743:Pyrimidines; D019057:Quality-Adjusted Life Years; D019438:Ritonavir / Q000191:economics* / Q000627:therapeutic use; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use; D019562:Viral Load / Q000187:drug effects; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D009570:Nitriles; D011724:Pyridazines; D011743:Pyrimidines; D013449:Sulfonamides; C451734:etravirine; D019438:Ritonavir; D000069454:Darunavir