title: Costs and cost-effectiveness analysis of 2015 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.
abstract: BACKGROUND
  GESIDA and the AIDS National Plan panel of experts suggest a preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2015. The objective of this study is to evaluate the costs and the effectiveness of initiating treatment with these regimens.
  
  
  METHODS
  Economic assessment of costs and effectiveness (cost/effectiveness) based on decision tree analyses. Effectiveness 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, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2015. A deterministic sensitivity 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 4663 Euros for 3TC+LPV/r (OR) to 10,902 Euros for TDF/FTC+RAL (PR). The effectiveness varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/effectiveness, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR) and RAL+DRV/r (OR), respectively.
  
  
  CONCLUSIONS
  The most efficient regimen was 3TC+LPV/r (OR). Among the PR and AR, the most efficient regimen was TDF/FTC/RPV (AR). Among the PR regimes, the most efficient was ABC/3TC+DTG.
authors: Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Juan
authors: J
authors: Berenguer
authors: Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía/IMIBIC, Cordoba, Spain. Electronic address: antoniojblasco@hotmail.com.
authors: Antonio
authors: A
authors: Rivero
authors: Independent Researcher, Madrid, Spain.
authors: Antonio Javier
authors: AJ
authors: Blasco
authors: Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain.
authors: José Ramón
authors: JR
authors: Arribas
authors: Unidad de Enfermedades Infecciosas, Hospital General de Alicante, Alicante, Spain.
authors: Vicente
authors: V
authors: Boix
authors: Fundació Lluita contra la Sida, Unitat VIH, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Irsicaixa, UVic, Barcelona, Spain.
authors: Bonaventura
authors: B
authors: Clotet
authors: Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Pere
authors: P
authors: Domingo
authors: Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain.
authors: Juan
authors: J
authors: González-García
authors: Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain.
authors: Hernando
authors: H
authors: Knobel
authors: Independent Researcher, Madrid, Spain.
authors: Pablo
authors: P
authors: Lázaro
authors: Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Juan Carlos
authors: JC
authors: López
authors: Fundació Lluita contra la Sida, Unitat VIH, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Josep M
authors: JM
authors: Llibre
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain.
authors: Fernando
authors: F
authors: Lozano
authors: Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors: José M
authors: JM
authors: Miró
authors: Unidad VIH, Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors: Daniel
authors: D
authors: Podzamczer
authors: Servicio de Farmacia, Hospital Clínic, Barcelona, Spain.
authors: Montserrat
authors: M
authors: Tuset
authors: Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors: Josep M
authors: JM
authors: Gatell
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D013030:Spain; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; Antiretroviral therapy; Cost; Costes; Effectiveness; Efficiency; Eficacia; Eficiencia; HIV; Sida; Tratamiento antirretroviral; Virus de la inmunodeficiencia humana