RESUMO
OBJECTIVES: To evaluate the cost effectiveness of dolutegravirâ¯+â¯abacavir/lamivudine (DTGâ¯+â¯ABC/3TC) compared with raltegravirâ¯+â¯abacavir/lamivudine (RALâ¯+â¯ABC/3TC) and ritonavir-boosted darunavirâ¯+â¯abacavir/lamivudine (DRV/râ¯+â¯ABC/3TC) in HIV-1-infected treatment-naive patients in Russia. METHODS: A dynamic Markov model was developed with five response states and six CD4+-based health states. Efficacy estimated as probability of viral suppression (HIV RNA <50 copies/ml) at 48 weeks was obtained from a published network meta-analysis. Baseline cohort characteristics and health state utilities were informed using DTG phase 3 clinical trials. Health care resource use was obtained from literature and costed using published unit costs. Costs (presented in Russian rubles) included antiretroviral drug costs; HIV management costs such as routine care; costs of treating cardiovascular conditions, opportunistic infections, and drug-related adverse effects; and mortality costs. A patient lifetime analysis was conducted using the societal perspective. Outcomes were quality-adjusted life-years (QALYs), life-years, incremental cost per QALY ratio, and incremental cost per responder. RESULTS: The viral suppression rate among patients receiving DTGâ¯+â¯ABC/3TC was 71.7% compared with 65.2% for RALâ¯+â¯ABC/3TC and 59.6% for DRV/râ¯+â¯ABC/3TC. The mean duration of response per patient was 116.6 months for DTGâ¯+â¯ABC/3TC, 108.6 months for RALâ¯+â¯ABC/3TC, and 98.9 months for DRV/râ¯+â¯ABC/3TC. Total discounted costs for treatment over patient lifetime were RUB 2.89, 5.32, and 4.38 million for DTGâ¯+â¯ABC/3TC, RALâ¯+â¯ABC/3TC, and DRV/râ¯+â¯ABC/3TC, respectively. Lifetime discounted QALYs were 12.73 for patients on DTGâ¯+â¯ABC/3TC and 12.72 each for patients on RALâ¯+â¯ABC/3TC and DRV/râ¯+â¯ABC/3TC. DTGâ¯+â¯ABC/3TC thus dominated the other two alternatives. CONCLUSIONS: With lower costs, higher response rates, and comparable QALYs, DTGâ¯+â¯ABC/3TC can be considered as a cost-effective alternative.
