Cost/efficacy analysis of preferred Spanish AIDS study group regimens and the dual therapy with lopinavir/ritonavir plus lamivudine for initial ART in HIV infected adults / Análisis de coste/eficacia de las pautas preferentes de GESIDA/Plan Nacional sobre el Sida y de biterapia con lopinavir/ritonavir más lamivudina para el tratamiento antirretroviral inicial en adultos infectados por el virus de la inmunodeficiencia humana

INTRODUCTION: The National AIDS Plan and the Spanish AIDS study group (GESIDA) proposes 'preferred regimens' (PR) of antiretroviral treatment (ART) as initial therapy in HIV-infected patients. In 2013, the recommended regimens were all triple therapy regimens. The Gardel Study assessed the efficacy of a dual therapy (DT) combination of lopinavir/ritonavir (LPV/r) plus lamivudine (3TC). Our objective is to evaluate the GESIDA PR and the DT regimen LPV/r+3TC cost/efficacy ratios. METHODS: Decision tree models were built. Efficacy: probability of having viral load < 50 copies/mL at week 48. ART regime cost: costs of ART, adverse effects, and drug resistance tests during the first 48 weeks. RESULTS: Cost/efficacy ratios varied between 5,817€ and 13,930 € per responder at 48 weeks, for the DT of LPV/r+3TC and tenofovir DF/emtricitabine+raltegravir, respectively. CONCLUSIONS: Taking into account the official Spanish prices of ART, the most efficient regimen was DT of LPV/r+3TC, followed by the triple therapy with non-nucleoside containing regimens

INTRODUCCIÓN: El Plan Nacional sobre el Sida y el grupo de estudio del SIDA-SEIMC (GESIDA) propone «regímenes preferentes» (RP) de tratamiento antirretroviral (TAR) como terapia inicial en pacientes infectados por VIH. Todos los regímenes recomendados en el año 2013 eran de terapia triple. El Estudio Gardel evaluó la eficacia de una doble terapia (DT) que combina lopinavir/ritonavir (LPV/r) más lamivudina (3TC). Nuestro objetivo es evaluar los ratios de coste/eficacia de los RP de GESIDA y el régimen de DT LPV/r+3TC. MÉTODOS: Construcción de árboles de decisión como modelos de evaluación económica. Eficacia: probabilidad de tener una carga viral <50 copias/ml en la semana 48. Coste del régimen de TAR: coste del TAR, efectos adversos y tests de resistencia durante las primeras 48 semanas. RESULTADOS: Los ratios de coste/eficacia variaron entre 5.817€ y 13.930€ por respondedor a las 48 semanas, para la DT LPV/r+3TC y tenofovir DF/emtricitabina+raltegravir, respectivamente. CONCLUSIONES: Con los precios oficiales españoles de TAR, el régimen más eficiente fue la DT con LPV/r+3TC, seguida de la terapia triple con regímenes que no contienen nucleósidos

Cost/efficacy analysis of preferred Spanish AIDS study group regimens and the dual therapy with lopinavir/ritonavir plus lamivudine for initial ART in HIV infected adults.

INTRODUCTION: The National AIDS Plan and the Spanish AIDS study group (GESIDA) proposes "preferred regimens" (PR) of antiretroviral treatment (ART) as initial therapy in HIV-infected patients. In 2013, the recommended regimens were all triple therapy regimens. The Gardel Study assessed the efficacy of a dual therapy (DT) combination of lopinavir/ritonavir (LPV/r) plus lamivudine (3TC). Our objective is to evaluate the GESIDA PR and the DT regimen LPV/r+3TC cost/efficacy ratios. METHODS: Decision tree models were built. EFFICACY: probability of having viral load <50 copies/mL at week 48. ART regime cost: costs of ART, adverse effects, and drug resistance tests during the first 48 weeks. RESULTS: Cost/efficacy ratios varied between 5,817 and 13,930 euros per responder at 48 weeks, for the DT of LPV/r+3TC and tenofovir DF/emtricitabine+raltegravir, respectively. CONCLUSIONS: Taking into account the official Spanish prices of ART, the most efficient regimen was DT of LPV/r+3TC, followed by the triple therapy with non-nucleoside containing regimens.