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Cost-Effectiveness of Single- Versus Generic Multiple-Tablet Regimens for Treatment of HIV-1 Infection in the United States

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  • Donna E. Sweet
  • Frederick L. Altice
  • Calvin J. Cohen
  • Björn Vandewalle

Abstract

Background: The possibility of incorporating generics into combination antiretroviral therapy and breaking apart once-daily single-tablet regimens (STRs), may result in less efficacious medications and/or more complex regimens with the expectation of marked monetary savings. A modeling approach that assesses the merits of such policies in terms of lifelong costs and health outcomes using adherence and effectiveness data from real-world U.S. settings. Methods: A comprehensive computer-based microsimulation model was developed to assess the lifetime health (life expectancy and quality adjusted life-years—QALYs) and economic outcomes in HIV-1 infected patients initiating STRs compared with multiple-table regimens including generic medications where possible (gMTRs). The STRs considered included tenofovir disoproxil fumarate/emtricitabine and efavirenz or rilpivirine or elvitegravir/cobicistat. gMTRs substitutions included each counterpart to STRs, including generic lamivudine for emtricitabine and generic versus branded efavirenz. Results: Life expectancy is estimated to be 1.301 years higher (discounted 0.619 QALY gain) in HIV-1 patients initiating a single-tablet regimen in comparison to a generic-based multiple-table regimen. STRs were associated with an average increment of $26,547.43 per patient in medication and $1,824.09 in other medical costs due to longer survival which were partially offset by higher inpatients costs ($12,035.61) with gMTRs treatment. Overall, STRs presented incremental lifetime costs of $16,335.91 compared with gMTRs, resulting in an incremental cost-effectiveness ratio of $26,383.82 per QALY gained. Conclusions: STRs continue to represent good value for money under contemporary cost-effectiveness thresholds despite substantial price reductions of generic medications in the U. S.

Suggested Citation

  • Donna E. Sweet & Frederick L. Altice & Calvin J. Cohen & Björn Vandewalle, 2016. "Cost-Effectiveness of Single- Versus Generic Multiple-Tablet Regimens for Treatment of HIV-1 Infection in the United States," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-19, January.
  • Handle: RePEc:plo:pone00:0147821
    DOI: 10.1371/journal.pone.0147821
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    References listed on IDEAS

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    1. Paul E Sax & Juliana L Meyers & Michael Mugavero & Keith L Davis, 2012. "Adherence to Antiretroviral Treatment and Correlation with Risk of Hospitalization among Commercially Insured HIV Patients in the United States," PLOS ONE, Public Library of Science, vol. 7(2), pages 1-10, February.
    2. Jagadish Guria & Joanne Leung & Michael Jones-Lee & Graham Loomes, 2005. "The Willingness to Accept Value of Statistical Life Relative to the Willingness to Pay Value: Evidence and Policy Implications," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 32(1), pages 113-127, September.
    3. Paul E Sax & Alexis Sypek & Bethany K Berkowitz & Bethany L Morris & Elena Losina & A David Paltiel & Kathleen A Kelly & George R Seage III & Rochelle P Walensky & Milton C Weinstein & Joseph Eron & K, 2014. "HIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-8, November.
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    1. Sophie Degroote & Linos Vandekerckhove & Dirk Vogelaers & Charlotte Vanden Bulcke, 2022. "Patient-reported outcomes among people living with HIV on single- versus multi-tablet regimens: Data from a real-life setting," PLOS ONE, Public Library of Science, vol. 17(1), pages 1-15, January.

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