title: The Epi-TAF for Tenofovir Disoproxil Fumarate?
abstract: Approximately 84% of human immunodeficiency virus (HIV)-infected US residents on antiretroviral therapy currently receive some form of tenofovir disoproxil fumarate (TDF) as part of their HIV treatment regimen. The TDF analogue tenofovir alafenamide (TAF) has demonstrated equal efficacy but with decreased renal injury and bone mineral density loss compared with TDF. We examine how much more society ought to be willing to pay for TAF over TDF, in exchange for its improved toxicity profile. Using cost-effectiveness methods, we find that current conditions warrant an annual premium of up to $1000 over the average wholesale price (AWP) of TDF. Once generic coformulations of tenofovir/lamivudine become accessible, however, the appropriate premium for TAF will likely merit a downward adjustment, using generic TDF-based costs as the benchmark.
authors.affiliation: Medical Practice Evaluation Center Division of Infectious Disease Division of General Internal Medicine, Massachusetts General Hospital Harvard University Center for AIDS Research, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.affiliation: Treatment Action Group, New York, New York.
authors.forename: Tim H
authors.initials: TH
authors.lastname: Horn
authors.affiliation: Yale School of Public Health, New Haven, Connecticut.
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001847:Bone Diseases / Q000139:chemically induced; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D000068698:Tenofovir / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D014481:United States
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir
keywords: cost-effectiveness; costs; generics; tenofovir alafenamide; tenofovir disoproxil fumarate