Cost-effectiveness of initial antiretroviral treatment administered as single vs. multiple tablet regimens with the same or different components.
To evaluate the efficiency of single-tablet regimens (STR) and multiple-tablet regimens (MTR) with exactly the same or different components.



A study was conducted on HIV-1-infected antiretroviral-naïve patients from 6 Spanish or French centers, who were started on treatment with STR-Atripla®, or the same components separately (MTR-SC), or a different MTR (MTR-Other). Effectiveness was measured as percentage of HIV-RNA <50copies/mL at 48 weeks (ITT). Efficiency was the ratio between costs (direct cost of antiretrovirals plus outpatient visits, hospital admissions, and resistance tests) and effectiveness.



The study included a total of 2773 patients (759 STR-Atripla®, 483 MTR-SC, and 1531 MTR-Other). Median age was 37 years, 15% were HCV co-infected, 27% had a CD4+ count <200cells/μL, and 30% had viral load ≥100.000copies/mL. The duration of the assigned treatment was longer for STR-Atripla®(P<.0001). Response rates (adjusted for CD4+ count, viral load, and clustered on hospitals) at 48 weeks were 76%, 74%, and 62%, respectively (P<.0001). Virological failure was more common in MTR patients (P=.0025), and interruptions due to intolerance with MTR-Other (P<.0001). Cost per responder at 48 weeks (efficiency) was €12,406 with STR-Atripla®, €11,034 with MTR-SC (0.89 [0.82, 0.99] times lower), and €18,353 (1.48 [1.38, 1.61] times higher) with MTR-Other.



STR-Atripla®and MTR-SC regimens showed similar effectiveness, but virological failure rate was lower with STR-Atripla. MTR-SC, considered less convenient, had a marginally better efficiency, mainly due to lower direct costs. MTR-Other regimens had both a worse effectiveness and efficiency. Similar efficiency analyses adjusting for baseline characteristics should be recommended for new STRs.
Infectious Diseases Department and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona, Spain. Electronic address: jmllibre@flsida.org.
Josep M
JM
Llibre
Fundació Clinic per a la Recerca Biomèdica, Hospital Clinic/IDIBAPS, Barcelona, Spain.
Elisa
E
de Lazzari
Infectious Diseases, St. Louis Hospital, Paris Diderot University, Paris, France.
Jean-Michel
JM
Molina
Infectious Diseases, St. Louis Hospital, Paris Diderot University, Paris, France.
Sébastien
S
Gallien
Infectious Diseases, Hospital La Paz, Madrid, Spain.
Juan
J
Gonzalez-García
HIV Unit, Infectious Disease Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain.
Arkaitz
A
Imaz
HIV Unit, Infectious Disease Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain.
Daniel
D
Podzamczer
Infectious Diseases Department and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain; Universitat Autònoma de Barcelona, Spain; UAB, UVIC-UCC, IEC, Spain.
Bonaventura
B
Clotet
Hospital de Sant Pau, Barcelona, Spain.
Pere
P
Domingo
Infectious Diseases & AIDS Units, Hospital Clinic/IDIBAPS, University of Barcelona, Barcelona, Spain.
Josep M
JM
Gatell
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013607:Tablets
D044966:Anti-Retroviral Agents; D004338:Drug Combinations; D013607:Tablets
Antiretroviral treatment; Combinaciones a dosis fijas; Coste-eficacia; Cost–effectiveness; Fixed-dose combinations; Regímenes de comprimido único; Single tablet regimens; Tratamiento antirretroviral