Simplificación del tratamiento antirretroviral: una buena alternativa para nuestros pacientes y para la sostenibilidad de nuestro sistema sanitario / Simplification of Antiretroviral Therapy: A Good Choice for Our Patients and the Sustainability of Our Health Care System

Objetivo Describir la efectividad, seguridad, adherencia y ahorro económico de la monoterapia basada en lopinavir/ritonavir. Método Estudio observacional, descriptivo y retrospectivo que evaluó la monoterapia. La adherencia se calculó utilizando un método objetivo. Se estimaron los costes directos derivados de la no dispensación de la triple terapia. Resultados Identificamos 17 pacientes. La adherencia por intervalos fue: >95%, 9 pacientes; 90-95%, 2 pacientes; 90-85%, 2 pacientes; inferior al 85%, 4 pacientes. La carga viral fue indetectable durante las semanas 12, 24, 36 y 48 excepto en 2 pacientes. Las cifras de CD4 se mantuvieron en la mayor parte de las analíticas >350 cél./μl, y solo un paciente tuvo una cifra inferior. El ahorro medio fue 4.819 euros/paciente/año (rango 1.116 - 8.700).Conclusiones En pacientes seleccionados la monoterapia puede ser una opción terapéutica coste-efectiva(AU)

Objective To describe the efficacy, safety, compliance and cost savings of lopinavir/ritonavir monotherapy. Method Observational, descriptive and retrospective study evaluating monotherapy. Adherence was calculated using an objective method. We estimated the direct costs of dispensing non-triple therapy. Results We identified 17 patients. Interval adherence was >95% in 9 patients, 90%–95% in 2 patients, 90%–85% in 2 patients, and less than 85% in 4 patients. Viral load was undetectable during weeks 12, 24, 36, and 48, except in 2 patients. The CD4 count in most analytical tests remained at >350cells/ml, only 1 patient had a lower figure. The average savings was 4819 Euros/patient/year (range 1116–8700).Conclusions In selected patients, monotherapy can be a cost-effective treatment option (AU)

Simplification of antiretroviral therapy: a good choice for our patients and the sustainability of our health care system.

OBJECTIVE: To describe the efficacy, safety, compliance and cost savings of lopinavir/ritonavir monotherapy. METHOD: Observational, descriptive and retrospective study evaluating monotherapy. Adherence was calculated using an objective method. We estimated the direct costs of dispensing non-triple therapy. RESULTS: We identified 17 patients. Interval adherence was > 95% in 9 patients, 90-95% in 2 patients, 90-85% in 2 patients, and less than 85% in 4 patients. Viral load was undetectable during weeks 12, 24, 36 and 48, except in 2 patients. The CD4 count in most analytical tests remained at > 350 cells/ml, only 1 patient had a lower figure. The average savings was 4819 Euros/patient/year (range 1116 to 8700). CONCLUSIONS: In selected patients, monotherapy can be a cost-effective treatment option.

[Cost-effectiveness analysis of tenofovir versus zidovudine in combination therapy with efavirenz and lamivudine for the treatment of HIV in naive patients]. / Análisis coste-eficacia de tenofovir versus zidovudina en terapia combinada con efavirenz y lamivudina para el tratamiento de VIH en pacientes no pretratados.

OBJECTIVES: To assess tenofovir + lamivudine + efavirenz versus zidovudine + lamivudine + efavirenz in treatment-naive patients using a cost-effectiveness analysis. METHODS: A decision tree was designed. Effectiveness was estimated from clinical trials. Viral load and CD4 cells count were chosen as endpoints for health outcome. Both healthcare and treatment costs were considered, and univariate sensitivity tests were performed. RESULTS: The regimen including tenofovir would have a yearly cost of 10,116.61 Euros when effective, and of 12,140.40 Euros in case of therapeutic failure. The regimen including zidovudine would have a yearly cost of 7,470.36 Euros when effective, and of 8,964.90 Euros in case of therapeutic failure. The cost of switching to the regimen with tenofovir represents 14,765.86 Euros per year per additional patient with non-detectable viral load. After 3 years, the expected yearly cost is 8,765.83 Euros for the regimen including tenofovir versus 8,894.36 Euros for the regimen including zidovudine. CONCLUSION: The regimen including zidovudine is less costly in the short run when compared to the regimen including tenofovir. Both regimens become financially similar when extending the study horizon.

Análisis coste-eficacia de tenofovir versus zidovudina en terapia combinada con efavirenz y lamivudina para el tratamiento de VIH en pacientes no pretratados / Cost-effectiveness analysis of tenofovir versus zidovudine in combination therapy with efavirenz and lamivudine for the treatment of HIV in naive patients

Objetivos: Evaluar los regímenes en pacientes no pretratados de tenofovir + lamivudina + efavirenz versus zidovudina + lamivudina + efavirenz mediante un estudio coste-eficacia. Métodos: Se diseñó un árbol de decisiones. Se estimó la eficaciaa través de ensayos clínicos. Para valorar la medida sobre los resultados de la salud se consideró la carga viral y los CD4. Se consideraron costes asistenciales y de tratamiento, y se realizó un análisis de sensibilidad univariante. Resultados: El régimen con tenofovir tendría un coste anual, en caso de ser efectivo, de 10.116,61 €, mientras que si existefallo terapéutico el coste sería de 12.140,40 €. El régimen que incluye zidovudina tendría un coste anual de 7.470,36 € en caso de ser efectivo, y un coste de 8.964,90 €, en caso de fallo terapéutico.El coste de pasar al régimen que incluye tenofovir supone 14.765,86 € al año por paciente adicional con carga viral indetectable. En 3 años, el coste anual esperado es de 8.765,83 € para el régimen que incluye tenofovir frente a 8.894,36 € del régimen que incluye zidovudina. Conclusión: El régimen que incluye zidovudina es menos costoso a corto plazo que el que incluye tenofovir. Si ampliamos el horizonte del estudio, los dos regímenes se equiparan económicamente

Objectives: To assess tenofovir + lamivudine + efavirenz versus zidovudine + lamivudine + efavirenz in treatment-naive patients using a cost-effectiveness analysis. Methods: A decision tree was designed. Effectiveness was estimated from clinical trials. Viral load and CD4 cells count were chosen as end points for health outcome. Both healthcare and treatment costs were considered, and univariate sensitivity tests were performed. Results: The regimen including tenofovir would have a yearly cost of € 10,116.61 when effective, and of € 12,140.40 in case of therapeutic failure. The regimen including zidovudine would have a yearly cost of € 7,470.36 when effective, and of € 8,964.90 incase of therapeutic failure. The cost of switching to the regimen with tenofovir represents € 14,765.86 per year per additional patient with non-detectable viral load. After 3 years, the expected yearly cost is € 8,765.83 for the regimen including tenofovir versus € 8,894.36 for the regimen including zidovudine. Conclusion: The regimen including zidovudine is less costly in the short run when compared to the regimen including tenofovir. Both regimens become financially similar when extending the study horizon