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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

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  • S. Boyer

    (Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale)

  • M. L. Nishimwe

    (Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale)

  • L. Sagaon-Teyssier

    (Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale
    ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur)

  • L. March

    (University of Montpellier)

  • S. Koulla-Shiro

    (Yaoundé Central Hospital)

  • M.-Q. Bousmah

    (Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale
    ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur)

  • R. Toby

    (Central Hospital)

  • M. P. Mpoudi-Etame

    (Region 1 Military Hospital)

  • N. F. Ngom Gueye

    (Fann Hospital)

  • A. Sawadogo

    (University Hospital Souro Sanou)

  • C. Kouanfack

    (Yaoundé Central Hospital
    Dschang University)

  • L. Ciaffi

    (University of Montpellier)

  • B. Spire

    (Aix Marseille Univ, INSERM, SESSTIM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale)

  • E. Delaporte

    (University of Montpellier
    University Hospital)

Abstract

Background 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. Methods 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. Results 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. Conclusions Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries. Trial Registration ClinicalTrials.gov Identifier: NCT00928187.

Suggested Citation

  • S. Boyer & M. L. Nishimwe & L. Sagaon-Teyssier & L. March & S. Koulla-Shiro & M.-Q. Bousmah & R. Toby & M. P. Mpoudi-Etame & N. F. Ngom Gueye & A. Sawadogo & C. Kouanfack & L. Ciaffi & B. Spire & E. D, 2020. "Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa," PharmacoEconomics - Open, Springer, vol. 4(1), pages 45-60, March.
    • Handle: RePEc:spr:pharmo:v:4:y:2020:i:1:d:10.1007_s41669-019-0157-9
    DOI: 10.1007/s41669-019-0157-9
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    References listed on IDEAS

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    1. Glick, Henry A. & Doshi, Jalpa A. & Sonnad, Seema S. & Polsky, Daniel, 2014. "Economic Evaluation in Clinical Trials," OUP Catalogue, Oxford University Press, edition 2, number 9780199685028.
    2. Elisabeth Fenwick & Bernie J. O'Brien & Andrew Briggs, 2004. "Cost‐effectiveness acceptability curves – facts, fallacies and frequently asked questions," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 405-415, May.
    3. Karen Schneider & Chidi Nwizu & Richard Kaplan & Jonathan Anderson & David P Wilson & Sean Emery & David A Cooper & Mark A Boyd, 2013. "The Potential Cost and Benefits of Raltegravir in Simplified Second-Line Therapy among HIV Infected Patients in Nigeria and South Africa," PLOS ONE, Public Library of Science, vol. 8(2), pages 1-7, February.
    4. World Bank, 2010. "World Development Indicators 2010," World Bank Publications - Books, The World Bank Group, number 4373.
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    1. Marwân-al-Qays Bousmah & Marie Libérée Nishimwe & Tamara Tovar-Sanchez & Martial Lantche Wandji & Mireille Mpoudi-Etame & Gwenaëlle Maradan & Pierrette Omgba Bassega & Marie Varloteaux & Alice Montoyo, 2021. "Cost-Utility Analysis of a Dolutegravir-Based Versus Low-Dose Efavirenz-Based Regimen for the Initial Treatment of HIV-Infected Patients in Cameroon (NAMSAL ANRS 12313 Trial)," PharmacoEconomics, Springer, vol. 39(3), pages 331-343, March.

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