Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa.

S. Boyer (1) , M. L. Nishimwe (1) , Luis Sagaon-Teyssier (1, 2) , L. March (3, 4, 5) , S. Koulla-Shiro (6) , Marwân-Al-Qays Bousmah (1, 2, 7) , R. Toby (6) , Mireille Mpoudi-Etame (8) , Ndeye Fatou Ngom Gueye (9) , A. Sawadogo (10) , C. Kouanfack (11) , L. Ciaffi (3, 4, 5) , Bruno Spire (1) , Eric Delaporte (3, 4, 12)

1 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
2 ORS PACA - Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille]
3 TransVIHMI - Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes
4 IRD [France-Sud] - Institut de Recherche pour le Développement
5 UM - Université de Montpellier
6 Hôpital Central de Yaoundé [Yaoundé]
7 CEPED - UMR_D 196 - Centre population et développement
8 Region 1 Military Hospital
9 Centre Hospitalo-Universitaire de Fann, Dakar
10 University Hospital Souro Sanou [Bobo-Dioulasso, Burkina Faso]
11 Hôpital Central de Yaoundé
12 Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France

While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle-income countries. We assessed the cost-effectiveness of three alternative bPI-based second-line regimens in Burkina Faso, Cameroon and Senegal. METHODS: We used data collected over 2010-2015 in the 2LADY trial/post-trial cohort. Patients with first-line antiretroviral therapy (ART) failure were randomly assigned to tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r; arm A), abacavir + didanosine + lopinavir/ritonavir (arm B), or tenofovir/emtricitabine + darunavir/ritonavir (arm C). Costs (US dollars, 2016), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were computed for each country over 24 months of follow-up and extrapolated to 5 years using a simulated patient-level Markov model. We assessed uncertainty using cost-effectiveness acceptability curves, scenarios and prices threshold analysis. RESULTS: In each country, over 24 months, arm A was significantly less costly than arms B and C (incremental costs ranging from US$410-$US721 and US$468-US$546 for B and C vs A, respectively) and offered similar health benefits (incremental QALY: - 0.138 to 0.023 and - 0.179 to 0.028, respectively). Over 5 years, arm A remained the least costly, health benefits not being significantly different between arms. Compared with arms B and C, in each study country, Arm A had a ≥ 95% probability of being cost-effective for a large range of cost-effectiveness thresholds, irrespective of the scenario considered. CONCLUSIONS: Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries.

Domaines: Sciences du Vivant [q-bio]; Maladies infectieuses

S. Boyer, M. L. Nishimwe, Luis Sagaon-Teyssier, L. March, S. Koulla-Shiro, et al.. Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa.. PharmacoEconomics - Open, 2020, 4 (1), pp.45-60. ⟨10.1007/s41669-019-0157-9⟩. ⟨hal-02510696⟩