PIN37 - Economic Evaluation Of Cobicistat-Boosted Darunavir In Hiv-Infected Patients In Mexico

Abstract

Cobicistat (cobi) is a new booster alternative whose physicochemical properties allow the co-formulation with darunavir to obtain the fixed dose combination of darunavir/cobicistat 800/150 mg (DRV/cobi) in a single tablet per day. This analysis aims to present the economic evaluation of darunavir in a daily dose of 800 mg boosted with 150 mg of cobi or with 100 mg of ritonavir (rtv) in the Mexican context. A complete economic evaluation was carried out through a cost minimization analysis since DRV/cobi and darunavir boosted with rtv (DRV+rtv) have shown bioequivalence in published studies. The efficacy of DRV/cobi is directed only by darunavir as it is the component with antiviral activity; cobi works as an enhancer to achieve optimal concentrations of darunavir in blood. Therefore, the efficiency shown by DRV+rtv is extrapolated to DRV/cobi. The costs of the drugs to calculate the annual cost of treatment were obtained from published sources (1USD = $ 19MXN). A deterministic sensitivity analysis was performed to test the robustness of the model. DRV/cobi showed annual savings per patient of 9.5%. This savings are equivalent to the annual cost of treatment with ritonavir. The annual cost of treatment with DRV/cobi is $2,096 versus the annual cost of DRV+ rtv which is $2,316. The robustness of the analysis was confirmed by a sensitivity analysis on the DRV/cobi acquisition price. The fixed dose combination in one tablet per day of DRV/cobi is a cost-saving and convenient alternative in terms of supply and storage for the institutions in the public health sector in Mexico that use DRV+rtv. Additionally, DRV/cobi favors adherence in patients and decreases the probability of virological failure.