title: Economic evaluation of initial antiretroviral therapy for HIV-infected patients: an update of Italian guidelines.
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) has allowed many HIV-infected patients to enjoy longer survival and a better quality of life. We performed an economic analysis to estimate the cost-effectiveness of HAART regimens in Italy for managing HIV-naïve infected patients with a viral load below 100,000 copies/mL.
  
  
  METHODS
  The population considered in the model consisted of adult subjects with an HIV viral load below 100,000 copies/mL who received antiretroviral HAART treatment for the first time, according to the Italian National Guidelines with recommendation grade A1. The incremental cost-effectiveness analysis of quality-adjusted life years (QALYs) was carried out by means of a Markov model. Both the outcomes (QALYs) and the costs were discounted by 3.5%. The time horizon adopted in the model was 10 years. The point of view of the analysis was that of the Italian national health service.
  
  
  RESULTS
  The tenofovir (TDF)/emtricitabine (FTC)/rilpivirine (RPV) single-tablet regimen (STR) (€7,417.00) revealed the lowest mean treatment cost. TDF/FTC + raltegravir (RAL) showed a better quality of life (0.906 QALY/year), followed by TDF/FTC/RPV (STR; 0.900 QALY/year), TDF/FTC + RPV (multipill regimen) (0.889 QALY/year), and TDF/FTC + atazanavir (ATV/r) (0.886 QALY/year). TDF/FTC/RPV (STR) appeared to be the most cost-effective therapeutic choice (€13,655.00), followed by TDF/FTC + RPV (multipill regimen) (€15,803.00), and TDF/FTC + efavirenz (EFV) (€16,181.00). The sensitivity analysis on the main variables confirmed the validity of the base case scenario.
  
  
  CONCLUSIONS
  STR (TDF/FTC/RPV) is the most cost-effective treatment strategy compared with the other therapeutic regimens recommended by the Italian guidelines for the treatment of naïve patients with a viral load <100,000 copies/mL. The inclusion of adverse-event management of HIV-infected patients affects the cost-effectiveness ratio of all HAART regimens.
authors.affiliation: Department of Drug Sciences, University of Pavia, Pavia, Italy ; SAVE - Studi Analisi Valutazioni Economiche, Milan, Italy.
authors.forename: Giorgio L
authors.initials: GL
authors.lastname: Colombo
authors.forename: Sergio
authors.initials: S
authors.lastname: Di Matteo
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Massimo
authors.initials: M
authors.lastname: Medaglia
authors.forename: Silvia
authors.initials: S
authors.lastname: Murachelli
authors.forename: Giuliano
authors.initials: G
authors.lastname: Rizzardini
keywords: HAART; HIV; Markov model; cost-effectiveness; single-tablet regimen (STR)