title: [Comparative cost-effectiveness analysis between darunavir/ritonavir and other protease inhibitors in treatment-naive human immunodeficiency syndrome type 1-infected patients in Spain].
abstract: BACKGROUND
  GESIDA (AIDS Study Group) has proposed preferred regimens of antiretroviral treatment as initial therapy in HIV infected patients. The objective of this analysis is to compare the costs and effectiveness of darunavir/r QD and other ritonavir-boosted (/r) protease inhibitors (PIs) currently recommended in GESIDA guidelines for treatment-naïve patients.
  
  
  METHODS
  A cost-efficacy model compared the boosted PIs recommended as preferred or alternative treatment choices, each used with a nucleoside reverse transcriptase inhibitor backbone. Efficacy was measured by 48-week virological response (viral load < 50 copies/mL) adjusted by baseline viral load and CD4 cell count. To generate efficiency frontiers and cost-efficacy ratios, one-year antiretroviral therapy costs in Spain, and 48-week efficacy values were used.
  
  
  RESULTS
  The model estimated that starting treatment with darunavir/r QD was the most cost-effective choice compared with the other preferred PI/r based therapies. The average cost per patient with a virological response was lower for darunavir/r QD (13,420€) than for atazanavir/r QD (14,000€), or lopinavir/r BID (13,815€). Among the preferred PI/r-based therapies, darunavir/r QD also was estimated to be the most efficient option for treatment-naïve patients. Atazanavir/r QD and lopinavir/r BID were found to be «dominated» by darunavir/r) and, consequently, were outside the efficiency frontier of PI/r-based first-line treatment. Given a fixed budget of 10 million euros for PI/r-based first-line therapy, the model estimated that darunavir/r QD would yield more responders (745) than atazanavir/r QD (714), or lopinavir/r BID (724). At the same time, darunavir/r QD would reduce the number of individuals failing treatment (150) compared with atazanavir/r QD (172) and lopinavir/r BID (286).
  
  
  CONCLUSIONS
  In this model, darunavir/r QD was found to be the most cost-effective choice, among the preferred PI/r-based therapies recommended in the Spanish guidelines for treatment-naïve patients.
authors.affiliation: Johnson & Johnson Pharmaceutical Services LLC, Beerse, Bélgica.
authors.forename: Erik
authors.initials: E
authors.lastname: Smets
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Brogan
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.forename: Ines
authors.initials: I
authors.lastname: Adriaenssen
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Sawyer
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo-Pedrol
authors.forename: Joana
authors.initials: J
authors.lastname: Gostkorzewicz
authors.forename: Francisco
authors.initials: F
authors.lastname: Ledesma
mesh_terms: D000328:Adult; D000069446:Atazanavir Sulfate; D003362:Cost-Benefit Analysis; D000069454:Darunavir; D005260:Female; D017320:HIV Protease Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D015497:HIV-1; D006801:Humans; D061466:Lopinavir / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D009842:Oligopeptides / Q000191:economics* / Q000627:therapeutic use*; D011725:Pyridines / Q000191:economics* / Q000627:therapeutic use*; D019438:Ritonavir / Q000191:economics* / Q000627:therapeutic use*; D013030:Spain; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D013449:Sulfonamides; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D019438:Ritonavir; D000069454:Darunavir