title: Health technology assessment in the HIV setting: the case of monotherapy.
abstract: Despite the success of multiple-drug therapy regimens, the idea of treating human immunodeficiency virus (HIV) infection with fewer drugs is captivating due to issues of convenience, long-term toxicities and costs. This study investigated the impact on a local health budget of the introduction of a protease inhibitor (PI)-based antiretroviral monotherapy. An analysis of 23,721 administrative records of HIV-infected patients and a health technology assessment (HTA) were performed to assess cost-effectiveness, budget, organizational, ethics, and equity impact. Data showed that monotherapy had a annual cost of € 7,076 (patient with undetectable viral load) and € 7,860 (patient with detectable viral load), and that its implementation would realise economic savings of between 12 and 24 million euro (between 4.80% and 9.72% of the 2010 total regional budget expenditure for HIV management) in the first year, with cumulated savings of between 48 and 145 million euro over the following five years. Organizational, ethical and equity impact did not indicate any significant differences. The study suggests that for specific categories of patients monotherapy may be an alternative to existing therapies. Its implementation would not result in higher operating costs, and would lead to a reduction in total expenditure.
authors.affiliation: CREMS (Centre for Research on Health Economics, Social and Health Care Management), Carlo Cattaneo University, LIUC, Castellanza (VA), Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Restelli
authors.forename: Davide
authors.initials: D
authors.lastname: Croce
authors.forename: Emanuele
authors.initials: E
authors.lastname: Porazzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Scolari
authors.forename: Marzia
authors.initials: M
authors.lastname: Bonfanti
authors.forename: Massimo
authors.initials: M
authors.lastname: Galli
authors.forename: Nicola
authors.initials: N
authors.lastname: Gianotti
authors.forename: Giuliano
authors.initials: G
authors.lastname: Rizzardini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Garagiola
authors.forename: Anna
authors.initials: A
authors.lastname: Vanzago
authors.forename: Emanuela
authors.initials: E
authors.lastname: Foglia
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D017320:HIV Protease Inhibitors / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D017320:HIV Protease Inhibitors