title: Costs and cost-efficacy analysis of the 2016 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 preferred (PR), alternative (AR), and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for the year 2016. The objective of this study is to evaluate the costs and the efficacy of initiating treatment with these regimens.
  
  
  METHODS
  Economic assessment of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/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 2016. 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 4663 Euros for 3TC+LPV/r (OR) to 10,894 Euros for TDF/FTC+RAL (PR). The efficacy 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/efficacy, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR), and RAL+DRV/r (OR), respectively.
  
  
  CONCLUSIONS
  Despite the overall most efficient regimen being 3TC+LPV/r (OR), among the PR and AR, the most efficient regimen was ABC/3TC/DTG (PR). Among the AR regimes, the most efficient was TDF/FTC/RPV.
authors.affiliation: Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Pérez-Molina
authors.affiliation: Independent Researcher, Madrid, Spain. Electronic address: antoniojblasco@hotmail.com.
authors.forename: Antonio Javier
authors.initials: AJ
authors.lastname: Blasco
authors.affiliation: Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Arribas
authors.affiliation: Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Crespo
authors.affiliation: Hospitals Universitaris Arnau de Vilanova & Santa María, Universitat de Lleida, Institut de Recerca Biomèdica (IRB) de Lleida, Lieida, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.affiliation: Hospital Clínico San Carlos, IdISSC; Universidad Complutense, Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Estrada
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Iribarren
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain.
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
authors.affiliation: Independent Researcher, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lázaro
authors.affiliation: Servicio de Medicina Interna y Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: López-Aldeguer
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: Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Alcalá de Henares, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Palacios
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Pineda
authors.affiliation: Unidad VIH, i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Pulido
authors.affiliation: Unidad VIH, i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rubio
authors.affiliation: Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de la Torre
authors.affiliation: Servicio de Farmacia, Hospital Clínic, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Tuset
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Gatell
mesh_terms: D019380:Anti-HIV 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: D019380:Anti-HIV Agents
keywords: AIDS; Antiretroviral therapy; Cost; Costes; Efficacy; EfficiencyHEAT32; Eficacia; Eficiencia; HIV; Sida; Tratamiento antirretroviral; VIH