title: Cost-utility analysis of lopinavir/ritonavir versus atazanavir + ritonavir administered as first-line therapy for the treatment of HIV infection in Italy: from randomised trial to real world.
abstract: OBJECTIVE
  To estimate the lifetime cost utility of two antiretroviral regimens (once-daily atazanavir plus ritonavir [ATV+r] versus twice-daily lopinavir/ritonavir [LPV/r]) in Italian human immunodeficiency virus (HIV)-infected patients naïve to treatment.
  
  
  METHODS
  With this observational retrospective study we collected the clinical data of a cohort of HIV-infected patients receiving first-line treatment with LPV/r or ATV+r.
  
  
  METHODS
  A Markov microsimulation model including direct costs and health outcomes of first- and second-line highly active retroviral therapy was developed from a third-party (Italian National Healthcare Service) payer's perspective. Health and monetary outcomes associated with the long-term use of ATV+r and LPV/r regimens were evaluated on the basis of eight health states, incidence of diarrhoea and hyperbilirubinemia, AIDS events, opportunistic infections, coronary heart disease events and, for the first time in an economic evaluation, chronic kidney disease (CKD) events. In order to account for possible deviations between real-life data and randomised controlled trial results, a second control arm (ATV+r 2) was created with differential transition probabilities taken from the literature.
  
  
  RESULTS
  The average survival was 24.061 years for patients receiving LPV/r, 24.081 and 24.084 for those receiving ATV+r 1 and 2 respectively. The mean quality-adjusted life-years (QALYs) were higher for the patients receiving LPV/r than those receiving ATV+r (13.322 vs. 13.060 and 13.261 for ATV+r 1 and 2). The cost-utility values were 15,310.56 for LPV/r, 15,902.99 and 15,524.85 for ATV+r 1 and 2.
  
  
  CONCLUSIONS
  Using real-life data, the model produced significantly different results compared with other studies. With the innovative addition of an evaluation of CKD events, the model showed a cost-utility value advantage for twice-daily LPV/r over once-daily ATV+r, thus providing evidence for its continued use in the treatment of HIV.
authors: CREMS (Centre for Research on Health Economics, Social and Health Care Management), University Carlo Cattaneo - LIUC, Castellanza, Varese, Italy.
authors: Emanuela
authors: E
authors: Foglia
authors: Paolo
authors: P
authors: Bonfanti
authors: Giuliano
authors: G
authors: Rizzardini
authors: Erminio
authors: E
authors: Bonizzoni
authors: Umberto
authors: U
authors: Restelli
authors: Elena
authors: E
authors: Ricci
authors: Emanuele
authors: E
authors: Porazzi
authors: Francesca
authors: F
authors: Scolari
authors: Davide
authors: D
authors: Croce
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D000069446:Atazanavir Sulfate; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D007558:Italy; D061466:Lopinavir / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D019438:Ritonavir