Abstract
BACKGROUND:Regimen simplification of ART, by administering them less frequently, has been suggested as a practical approach to improve adherence. The aim of this study was to assess the cost-utility of once-daily (QD) versus twice-daily (BID) antiretroviral (ART) regimens in the treatment of HIV. METHODS:A Model-based Markov modelling of cost-effectiveness using secondary data sources was developed to determine the incremental cost per quality-adjusted life year (QALY) gained of QD versus BID ART regimen for a hypothetical cohort treatment-naïve adults with HIV, from the Sub-Saharan African healthcare payer’s perspective. RESULTS:At base-case values for all parameters, the total number of QALY gained by QD regimen was 0.27 and the incremental cost difference of $2147.04. The incremental cost-effectiveness ratio (ICER) of QD versus BID regimen was $8087/QALY gained. The ICER was most sensitive to the variations in the total medical cost of state A (asymptomatic, non-AIDS, CD4> 350 cells/μL), total medical Cost State D (symptomatic AIDS or severe symptoms), and utility of State A. In our bootstrap analysis, 60% of bootstrap replicates for the ICER shows that QD is more costly and more effective than BID regimen, while the remaining 40% replicates shows that QD is less costly and less effective than BID. If decision-makers were willing to pay $1000 per QALY gained, the probability of QD being cost-effective was 44%. The probability of QD regimen being cost-effective was 48% when the willing to pay was $5000. CONCLUSIONS:From a sub-Saharan Africa societal perspective QD regimen cannot be regarded as cost-effective, although there is substantial decision uncertainty. Findings from the economic evaluation are important for low- and middle-income countries (LMIC) to consider as they decide whether to adopt the new branded single tablet regimen. Generic-based ART could yield substantial budgetary saving to HIV programmes in LMIC.
Highlights
Regimen simplification of ART, by administering them less frequently, has been suggested as a practical approach to improve adherence
It is estimated that in 2012, as much as 68% of all people infected with human immunodeficiency virus (HIV) were living in Sub-Saharan Africa (SSA), and about 20% of all deaths and disability adjusted life years (DALYs) lost in Africa are due to HIV or acquired immunodeficiency syndrome (AIDS)[1]
Model structure We developed a computer-based mathematical model of HIV infection to simulate the effect of QD versus BID regimen (Figure 1)
Summary
Regimen simplification of ART, by administering them less frequently, has been suggested as a practical approach to improve adherence. The aim of this study was to assess the cost-utility of once-daily (QD) versus twice-daily (BID) antiretroviral (ART) regimens in the treatment of HIV. METHODS: A Model-based Markov modelling of cost-effectiveness using secondary data sources was developed to determine the incremental cost per quality-adjusted life year (QALY) gained of QD versus BID ART regimen for a hypothetical cohort treatment-naïve adults with HIV, from the Sub-Saharan African healthcare payer’s perspective. The incremental cost-effectiveness ratio (ICER) of QD versus BID regimen was $8087/QALY gained. It has been documented that optimal adherence to ART is associated with good viral suppression, slowing of disease progress and reduced all-cause mortality in people living with HIV5,6. One of the most important advances is decreasing the dosing frequency and pill burden from more than 10 tablets to a one table once a day (QD) fixed dose combination[4]
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