ART with Two dolutegravir-lamivudine drugs would be cost-effective and would obtain broad financial savings and facilitate adherence

Virological suppression test with anti-retroviral first-line treatment using a drug regimen of dolutegravir (Tivicay) And lamivudine, would be highly profitable and could save the health system about $ 500 million over five years, according to the results of a mathematical model published in the online edition of Clinicalinfectious diseases.

The Switching from one quarter of immunosuppressed patients for the procedure using the combination of two drugs could reach five annual savings of $ 3 billion.

"We want to demonstrate that induction therapies maintenance strategy with three initial drugs with DTG / ABC / 3TC [dolutegravir / abacavir / lamivudine] followed by DTG + 3TC as maintenance scheme would have cost-effective in the United States under plausible hypotheses virological efficacy and DTG + 3TC as initial therapy could be even more effective in terms of cost, "the researchers comment. "We found that the induction and maintenance of two drugs strategies, if adopted, could save more than $ 500 million, or $ 800 million, respectively, in patients with HIV, therapy costs in the first five years, compared with the Current standard of care. "

The findings are described as "important" by the authors of an editorial suggesting that the cost savings achieved effectively double-drug therapy could be used to improve engagement rates and retention in care, both fundamental to control the epidemic HIV in the United States.

First line therapy HIV is usually composed of three antiretroviral drugs into two distinct classes. This treatment usually costs upwards of 30.000 dollars per patient / year.

The results of a pilot study presented at the15th European AIDS Conferencethis year showed that the first line of treatment with only two drugs - a potent inhibitor of integrase dolutegravir lamivudine - had excellent efficacy for virological 48 weeks, with a good safety / toxicological profile. Full results will be published in 2016 year.

The researchers wanted to see if this double combination of drugs could be effective in terms of costs and estimate the potential savings that could be achieved if it were used in the first line of treatment strategies.

They built a model involving four treatment strategies for patients in the United States.

  • Treatment - for modeling comparison.
  • Initial treatment with dolutegravir and lamivudine.
  • Induction and maintenance therapy - an initial three medications from dolutegravir / abacavir / lamivudine, followed by maintenance therapy with lamivudine dolutegravir in patients with virological suppression 48 weeks after induction therapy.
  • Drug-therapy service standard three-drug dolutegravir / abacavir / lamivudine.

The authors calculated the cost-effectiveness (defrost) for each strategy over the next least expensive strategy. The strategy was considered cost-effective if the DEFROST was below the threshold of $ 100.000 dollars per quality of life year (QALY). Quality of life per year in health economic terms is a year of perfect health and the thaw is the extra cost of buying a year of perfect health with a new intervention from the current level of care.

It is estimated that 93% of patients have virologic suppression 48 weeks after drug treatment. The researchers have adopted a prudent approach to double-drug therapy efficacy, assuming that 87% of patients have a viral load below 50 copies / ml after initiation of treatment with this combination. They also assumitam virologic failure in 0,6% per month rate for patients taking two drugs maintenance therapy; This compared to a monthly failure rate 0,1% for patients who received the standard treatment.

After applying the discount, the annual cost of treatment dolutegravir / abacavir / lamivudine was $ 24.500 dolutegravir and annual treatment with lamivudine was estimated as costing $ 15.200.

The survival rate at five years was 90% for standard of care, the induction and maintenance therapy and two medical treatment. The proportion of patients who remained in first-line treatment in the fifth year ranged from 97% for patients who received standard treatment and 89% for patients who received the two-drug therapies the 1st.

In relation to any type of treatment, the DEFROST for induction and maintenance therapy was $ 22.500 / QALY. Regarding the induction and maintenance therapy, the standard of care of DEFROST was over $ 500.000 / QALY and was not effective in terms of costs. The clinical and economic results of two drug treatment were almost identical to the induction and maintenance therapy (DEFROST compared to no treatment, 26000 $ / QALY).

50% uptake by patients starting ART maintenance induction therapy or therapy with two drugs was calculated to achieve "five years" reduction of US costs $ 550 800 million and $ million, respectively. Economy reached $ 3 billion if 25% of immunosuppressed patients were linked to dolutegravir-lamivudine therapy.

"Given the great potential for economic benefit along with excellent clinical results, the next pilot study data are promising, some clinical trials fully equipped to evaluate the non-inferiority of these strategies should be made," the researchers conclude.

The findings are described as "innovative and attractive" in publishing, the authors commented, "strategies with two drugs offer real possibilities to reduce the anti-HIV treatment costs, not only in the US but in other countries."

Written by

Michael Carter
Published: 17 December 2015

Reference

Girouard MP et al.The cost-effectiveness and budget impact of two-drug dolutegravir-lamivudine regimens for the treatment of HIV infection in the United States. Clin Infect Dis, online edition, 2015.

SP Koenig et al.Stemming the tide: can new approaches to HIV treatment reverse the trend of rising drug prices in the United States?Clin Infect Dis, online edition, 2015.