Cost-effectiveness of lopinavir/ritonavir versus nelfinavir as the first-line highly active antiretroviral therapy regimen for HIV infection.

PURPOSE: Selecting the optimal treatment regimen for antiviral-naive patients may be difficult, given the concern about the antiviral activity, the development of drug resistance, and the increase in drug costs. This study evaluates the costs and effectiveness of using lopinavir/ritonavir (LPV/r) vs. nelfinavir (NFV), both coadministered with stavudine and lamivudine, as the first HAART regimen in treating HIV patients, based on the results from the published clinical trial M98-863. METHOD: A Markov model was developed using a combination of viral load (VL) and CD4 count as surrogate markers to define health states. VL and CD4 count data from the 48-week analysis of the clinical trial were used as measures of effect. The impact of resistance difference between NFV and LPV/r was also examined. RESULTS: Over the first 5 years, the model estimated that LPV/r could save $3,461 USD per patient in total HIV care costs compared with NFV. If the resistance advantage of LPV/r was taken into account, the cost savings by LPV/r increased to $5,546 USD. For longer term projection, without considering the resistance difference, the incremental cost-effectiveness ratio (CER) for LPV/r vs. NFV was $6,653 USD per quality-adjusted life-year (QALY). This CER compares favorably to therapies for HIV disease and for common drug treatments for other conditions and is well within accepted thresholds for health policy makers. CONCLUSION: When treatment options are being considered, this study suggests that use of LPV/r in the first antiretroviral regimen, as compared to NFV, is cost-effective based on improved efficacy and resistance.

Nelfinavir access in Canada.

AIDS: Due to the licensing of Nelfinavir in Canada, Agouron Pharmaceuticals will stop enrolling subjects into its Nelfinavir expanded access program. Current participants will continue receiving the drug under the program for up to 90 days following licensing or when private insurance coverage is granted. A toll-free number is provided for those needing help with finding payment options for Nelfinavir.^ieng

Nelfinavir (Viracept) price increase 4.6 percent.

AIDS: Agouron Pharmaceuticals is raising the price of its protease inhibitor Nelfinavir (Viracept) by 4.6 percent. The total cost increase for the drug could be 15 percent for people on twice-daily dosing. The cost increase is attributed to research and development costs for other new products and to an unfavorable financial market, which makes it difficult to obtain investment funding.^ieng