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Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa

2019; Adis, Springer Healthcare; Volume: 4; Issue: 1 Linguagem: Inglês

10.1007/s41669-019-0157-9

2509-4254

Sylvie Boyer, Marie Libérée Nishimwe, Luis Sagaon‐Teyssier, Laura March, Sinata Koulla‐Shiro, Marwân‐al‐Qays Bousmah, R. Toby, Mireille Mpoudi-Etame, Ndèye Fatou Ngom Gueye, A Sawadogo, Charles Kouanfack, Laura Ciaffi, Bruno Spire, Éric Delaporte, Éric Delaporte, Sinata Koulla‐Shiro, Cheikh Ndour, A Sawadogo, Vincent Le Moing, Jacques Reynes, Alexandra Calmy, Laura Ciaffi, Pierre Marie Girard, Serge Eholié, Marie‐Laure Chaix, Charles Kouanfack, Ioana Cristina Tita, Brigitte Bazin, Paula Garcia, Jean–Baptiste Guiard–Schmid, Suzanne Izard, Sabrina Eymard‐Duvernay, Martine Peeters, Laetitia Serrano, Amandine Cournil, Ismaïla Diallo, Jean-Marc Mben, R. Toby, N.M. Manga, Liliane Ayangma, B. Taman, Nongodo Firmin Kaboré, E. Kamboulé, J. Zoungrana, Assane Diouf, Mamadou Diallo, Luana da Silva Fortes, Ndèye Fatou Ngom Gueye, Gabriela Batista, Avelin F. Aghokeng, Emilande Guichet, Hortence Abessolo, Claudine Ntsama Essomba, Godfrey Manirakiza, Frida Essomba, T. Mbarga, S. Epanda, Angeline Bikié, T Nké, N. Massaha, E. Nke, Maguy Ngolle, D. Bikobo, L. Abologo, O. Elat, Gabrièle Laborde-Balen, Assane Diop, Babacar Diouf, N. Bara, Maouly Fall, C. Touré Kane, Fatou Seck, S. Ba, P. Njantou, A. Ndyaye, Arsène Héma, Paulin Fao, P. Ouedrago, René Traoré, Yves Sanou, Guillaume Bado, Mamady Coulibaly, Eric Nagaonlé Somé, J. Some, A. Elisée Sié Kambou, Arnaud S. R. Tapsoba, Diamasso Sombié, S. Sanou, B. Traore, P. Flandre, Camille Michon, J. Drabo, François Simon,

HIV-related health complications and treatments

While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle-income countries. We assessed the cost-effectiveness of three alternative bPI-based second-line regimens in Burkina Faso, Cameroon and Senegal. We used data collected over 2010–2015 in the 2LADY trial/post-trial cohort. Patients with first-line antiretroviral therapy (ART) failure were randomly assigned to tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r; arm A), abacavir + didanosine + lopinavir/ritonavir (arm B), or tenofovir/emtricitabine + darunavir/ritonavir (arm C). Costs (US dollars, 2016), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were computed for each country over 24 months of follow-up and extrapolated to 5 years using a simulated patient-level Markov model. We assessed uncertainty using cost-effectiveness acceptability curves, scenarios and prices threshold analysis. In each country, over 24 months, arm A was significantly less costly than arms B and C (incremental costs ranging from US$410–$US721 and US$468–US$546 for B and C vs A, respectively) and offered similar health benefits (incremental QALY: − 0.138 to 0.023 and − 0.179 to 0.028, respectively). Over 5 years, arm A remained the least costly, health benefits not being significantly different between arms. Compared with arms B and C, in each study country, Arm A had a ≥ 95% probability of being cost-effective for a large range of cost-effectiveness thresholds, irrespective of the scenario considered. Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries. ClinicalTrials.gov Identifier: NCT00928187.