Dataset Information

The clinical role and cost-effectiveness of long-acting antiretroviral therapy.

ABSTRACT:

Background

Long-acting antiretroviral therapy (LA-ART) is currently under development and could improve outcomes for human immunodeficiency virus (HIV)-infected individuals with poor daily ART adherence.

Methods

We used a computer simulation model to evaluate the cost-effectiveness of 3 LA-ART strategies vs daily oral ART for all: (1) LA-ART for patients with multiple ART failures; (2) second-line LA-ART for those failing first-line therapy; and (3) first-line LA-ART for ART-naive patients. We calculated the maximum annual cost of LA-ART at which each strategy would be cost-effective at a willingness to pay of $100 000 per quality-adjusted life-year. We assumed HIV RNA suppression on daily ART ranged from 0% to 91% depending on adherence, vs 91% suppression on LA-ART regardless of daily ART adherence. In sensitivity analyses, we varied adherence, efficacy of LA-ART and daily ART, and loss to follow-up.

Results

Relative to daily ART, LA-ART increased overall life expectancy by 0.15-0.24 years, and by 0.51-0.89 years among poorly adherent patients, depending on the LA-ART strategy. LA-ART after multiple failures became cost-effective at an annual drug cost of $48 000; in sensitivity analysis, this threshold varied from $40 000-$70 000. Second-line LA-ART and first-line LA-ART became cost-effective at an annual drug cost of $26 000-$31 000 and $24 000-$27 000, vs $28 000 and $25 000 for current second-line and first-line regimens.

Conclusions

LA-ART could improve survival of HIV patients, especially those with poor daily ART adherence. At an annual cost of $40 000-$70 000, LA-ART will offer good value for patients with multiple prior failures. To be a viable option for first- or second-line therapy, however, its cost must approach that of currently available regimens.

SUBMITTER: Ross EL

PROVIDER: S-EPMC4366583 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Publications

The clinical role and cost-effectiveness of long-acting antiretroviral therapy.

Ross Eric L EL Weinstein Milton C MC Schackman Bruce R BR Sax Paul E PE Paltiel A David AD Walensky Rochelle P RP Freedberg Kenneth A KA Losina Elena E

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20150112 7

<h4>Background</h4>Long-acting antiretroviral therapy (LA-ART) is currently under development and could improve outcomes for human immunodeficiency virus (HIV)-infected individuals with poor daily ART adherence.<h4>Methods</h4>We used a computer simulation model to evaluate the cost-effectiveness of 3 LA-ART strategies vs daily oral ART for all: (1) LA-ART for patients with multiple ART failures; (2) second-line LA-ART for those failing first-line therapy; and (3) first-line LA-ART for ART-naive ...[more]

PMID: 25583979

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Dataset Information

The clinical role and cost-effectiveness of long-acting antiretroviral therapy.

Background

Methods

Results

Conclusions

Publications

The clinical role and cost-effectiveness of long-acting antiretroviral therapy.

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