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Cost-Effectiveness Analysis of Lopinavir/Ritonavir Monotherapy Versus Standard Combination Antiretroviral Therapy in HIV-1 Infected Patients with Viral Suppression in France (ANRS 140 DREAM)

dc.rights.licenseopenen_US
dc.contributor.authorGARAY, O. U.
dc.contributor.authorNISHIMWE, M. L.
dc.contributor.authorBOUSMAH, M. A.
dc.contributor.authorJANAH, A.
dc.contributor.authorGIRARD, P. M.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorCHENE, Genevieve
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorMOINOT, Laetitia
dc.contributor.authorSAGAON-TEYSSIER, L.
dc.contributor.authorMEYNARD, J. L.
dc.contributor.authorSPIRE, B.
dc.contributor.authorBOYER, S.
dc.date.accessioned2020-06-08T12:00:54Z
dc.date.available2020-06-08T12:00:54Z
dc.date.issued2019-12
dc.identifier.issn2509-4254 (Electronic) 2509-4262 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/7813
dc.description.abstractEnBACKGROUND: Protease inhibitor monotherapy is a simplified treatment strategy for virally suppressed HIV-positive patients that has the potential for cost savings, as fewer drugs are used than with combination therapy. However, evidence for its economic value is limited. OBJECTIVES: We assessed the cost-effectiveness of lopinavir/ritonavir monotherapy followed by treatment intensification in case of viral load rebound versus combination antiretroviral therapy (cART) with efavirenz/emtricitabine/tenofovir in HIV-1 infected patients with viral suppression in the ANRS 140 DREAM trial. METHODS: DREAM was conducted in 36 French Hospitals between 2009 and 2013. For each treatment strategy, we estimated the unadjusted and multivariate-adjusted mean costs (in euro, year 2010 values) and quality-adjusted life-years (QALYs) per patient, as well as incremental costs and QALYs per patient. We then assessed uncertainty using the cost-effectiveness acceptability curve, scenario analyses and cost-effectiveness price-threshold (CEPT) analysis. RESULTS: In the base-case analysis considering 2009-2013 antiretroviral drug (ARV) prices, adjusted incremental costs and QALYs were - euro3296 (95% confidence interval [CI] - 5202 to - 1391) and 0.006 (95% CI - 0.021 to 0.033), respectively, over 2 years, suggesting that monotherapy was cost-effective with a probability of 100% at various cost-effectiveness thresholds. In scenario analyses considering 2018 ARV prices, monotherapy remained cost-effective but with a lower probability (94% vs. 100% in the base-case analysis). The current price of cART would have to decrease by 34% to be cost-effective with a probability of 95%. CONCLUSION: Monotherapy appears to be cost-effective compared with cART for virologically suppressed HIV-positive patients in France. CEPT analysis is a useful tool to identify the preferred strategy to adopt given that ARV prices change rapidly. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00946595.
dc.language.isoENen_US
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subject.enMORPH3Eus
dc.title.enCost-Effectiveness Analysis of Lopinavir/Ritonavir Monotherapy Versus Standard Combination Antiretroviral Therapy in HIV-1 Infected Patients with Viral Suppression in France (ANRS 140 DREAM)
dc.title.alternativePharmacoecon Openen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1007/s41669-019-0130-7en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed30968368en_US
bordeaux.journalPharmacoecon Openen_US
bordeaux.page505-515en_US
bordeaux.volume3en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - U1219en_US
bordeaux.issue4en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.exportfalse
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Pharmacoecon%20Open&rft.date=2019-12&rft.volume=3&rft.issue=4&rft.spage=505-515&rft.epage=505-515&rft.eissn=2509-4254%20(Electronic)%202509-4262%20(Linking)&rft.issn=2509-4254%20(Electronic)%202509-4262%20(Linking)&rft.au=GARAY,%20O.%20U.&NISHIMWE,%20M.%20L.&BOUSMAH,%20M.%20A.&JANAH,%20A.&GIRARD,%20P.%20M.&rft.genre=article


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