title: Costs and cost-efficacy analysis of the 2014 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.
abstract: BACKGROUND
  GESIDA and the National AIDS Plan panel of experts suggest preferred (PR) and alternative (AR) regimens of antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2014. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these regimens.
  
  
  METHODS
  An economic assessment was made of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied by considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and costs correspond to those of 2014. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable.
  
  
  RESULTS
  In the base case scenario, the cost of initiating treatment ranges from 5133 Euros for ABC/3TC+EFV to 11,949 Euros for TDF/FTC+RAL. The efficacy varies between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.89 for TDF/FTC/EVG/COBI. Efficiency, in terms of cost/efficacy, ranges from 7546 to 13,802 Euros per responder at 48 weeks, for ABC/3TC+EFV and TDF/FTC+RAL respectively.
  
  
  CONCLUSIONS
  Considering ART official prices, the most efficient regimen was ABC/3TC+EFV (AR), followed by the non-nucleoside containing PR (TDF/FTC/RPV and TDF/FTC/EFV). The sensitivity analysis confirms the robustness of these findings.
authors.affiliation: Técnicas Avanzadas de Investigación en Servicios de Salud (TAISS), Madrid, Spain.
authors.forename: Antonio Javier
authors.initials: AJ
authors.lastname: Blasco
authors.affiliation: Fundació Lluita contra la Sida, Unitat VIH, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Llibre
authors.affiliation: Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Berenguer
authors.affiliation: Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: González-García
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain.
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lozano
authors.affiliation: Unidad VIH, Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
authors.affiliation: Unidad de VIH, Hospital Universitario 12 de Octubre, i+12, Madrid, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Pulido
authors.affiliation: Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
authors.affiliation: Servicio de Farmacia, Hospital Clínic, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Tuset
authors.affiliation: Técnicas Avanzadas de Investigación en Servicios de Salud (TAISS), Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lázaro
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain. Electronic address: gatell0@attglobal.net.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Gatell
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics; D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D017410:Practice Guidelines as Topic; D013030:Spain
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; Antiretrovirals; Antirretrovirales; Cost; Costes; Efficacy; Efficiency; Eficacia; Eficiencia; HIV; Sida; Therapy; Tratamiento; VIH