12th Annual Conference of the British HIV Association 29 March–1 April 2006, Brighton, UK

COST-EFFECTIVENESS OF NNRTI VERSUS PI-CONTAINING HAART REGIMENS IN UK NPMS-HHC CLINICS, 1996–2002

HIV Med 2006; 7(Suppl. 1):13 (abstract no. P8)

Eddy Beck¹, Sundhiya Mandalia¹, Ray Brettle², Martin Fisher², Mark Gompels², George Kinghorn², Brendan McCarron², Anton Pozniak², Alan Tang², John Walsh², Ian Williams², Mike Youle¹ and Brian Gazzard^1
1 NPMS-HHC CAC, London, ² NPMS-HHC Sites, UK Cities, UK

AIMS: To estimate the cost-effectiveness of NNRTI versus PI-containing first- line HAART regimens.

METHODS: Cox’s proportional hazard regression models were used to estimate likelihood of treatment failure for different first-line HAART regimens. Analyses were adjusted for gender, age, baseline viral load, CD4 count and CDC diagnosis and stratified by year of starting HAART. Log rank survival analyses were extrapolated using least-squares maximum-likelihood method to estimate treatment-failure time. Annual cost of care estimated for different regimens and discounted at 3.5% (2002 prices). The cost-effectiveness analyses compared different PI-containing first-line HAART regimens with 2NRTIs + NNRTI.

RESULTS: Median time to treatment failure for 2NRTIs + NNRTI was 4832 days (IQR = 2332–7332), 1571 days for 2NRTIs + PI (IQR = 738–2404), 2378 days for 2NNRTs + 2PIs (IQR = 1128–3628) and 1631 days for 2NRTIs + PI_boosted (IQR = 798–2464) (P<0.001). Annual hospital care cost was ≤12 199 for 2NRTIs + NNRTI, ≤14060 for 2NRTIs + PI, ≤19703 for 2NNRTIs + 2PIs and ≤14049 for 2NRTIs + PI_boosted. The cost-effectiveness of first-line 2NRTIs + NNRTI versus 2NRTIs + PI was ≤8079 per life year gained (LYG), ≤8236 per LYG for 2NRTIs + NNRTI compared with 2NRTIs + PI_boosted and ≤1962 per LYG for 2NRTIs + NNRTI compared with 2NRTIs + 2PI.

CONCLUSION: People on first-line 2NRTIs + NNRTI had longest estimated time to treatment failure, lowest annual hospital costs and regimen was cost- effective compared with the PI-containing first-line regimens. Given the increasing number of people living with HIV in high, middle and low income countries, cost and cost-effectiveness of regimens are becoming increasingly important criteria for deciding which particular regimen to use for first-line HAART.

2006-03-29
P8

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