title: Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Naive and Treatment-Experienced Patients in Canada.
abstract: BACKGROUND
  The Antiretroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model was adapted to evaluate the cost-effectiveness of dolutegravir (DTG) in Canada in treatment-naive (TN) and treatment-experienced (TE) human immunodeficiency virus (HIV)-1 patients.
  
  
  METHODS
  The ARAMIS-DTG model is a microsimulation model with a lifetime analytic time horizon and a monthly cycle length. Markov health states were defined by HIV health state (with or without opportunistic infection). DTG was compared to efavirenz (EFV), raltegravir (RAL), darunavir/ritonavir, rilpivirine (RPV), elvitegravir/cobicistat, atazanavir/ritonavir and lopinavir/ritonavir in TN patients and to RAL in TE patients. The initial cohort, the main efficacy data and safety data were derived from phase III clinical trials. Treatment algorithms were based on expert opinion. Costs normalized to the year 2013 included antiretroviral treatment cost, testing, adverse event, HIV and cardiovascular disease care and were derived from the literature.
  
  
  RESULTS
  Dolutegravir was estimated to be the dominant strategy compared with all comparators in both TN and TE patients. Treatment with DTG was associated with additional quality-adjusted life-years that ranged from 0.17 (vs. RAL) to 0.47 (vs. EFV) in TN patients and was 0.60 in TE patients over a lifetime. Cost savings ranged from Can$1393 (vs. RPV) to Can$28,572 (vs. RAL) in TN patients and amounted to Can$3745 in TE patients. Sensitivity analyses demonstrated the robustness of the model.
  
  
  CONCLUSIONS
  Dolutegravir is a dominant strategy in the management of TN and TE patients when compared to recommended comparators. This is mainly related to the high efficacy and high barrier to resistance.
  
  
  BACKGROUND
  ViiV Healthcare.
authors.affiliation: Mapi, Nanterre, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Despiégel
authors.affiliation: Mapi, Nanterre, France. danger@mapigroup.com.
authors.forename: Delphine
authors.initials: D
authors.lastname: Anger
authors.affiliation: Mapi, Uxbridge, UK.
authors.forename: Monique
authors.initials: M
authors.lastname: Martin
authors.affiliation: GlaxoSmithKline, Mississauga, ON, Canada.
authors.forename: Neerav
authors.initials: N
authors.lastname: Monga
authors.affiliation: GlaxoSmithKline, Mississauga, ON, Canada.
authors.forename: Qu
authors.initials: Q
authors.lastname: Cui
authors.affiliation: Athena Research, Burlington, ON, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Rocchi
authors.affiliation: Becton, Dickinson and Company, Franklin Lakes, NJ, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pulgar
authors.affiliation: GlaxoSmithKline, King of Prussia, PA, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Gilchrist
authors.affiliation: GlaxoSmithKline, Brentford, UK.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Refoios Camejo
keywords: Canada; Cost-effectiveness; Dolutegravir; HIV; Treatment naive