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Sixth International CongressDrug Therapy in HIV Infection17-21 November, 2002
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Selecting the optimal treatment regimen for antiretroviral (ARV)-naïve patients may be difficult, given the concern about the antiviral activity, the development of drug resistance and the increase in drug costs. This study was undertaken to evaluate the costs and effectiveness of using lopinavir/ritonavir (LVP/r) vs. nelfinavir (NFV) as the first HAART regimen in treating HIV patients, based on the results from the recently published clinical trial ABTM98-8631.
A new generation three-compartment Markov model was developed with a combination of viral load (VL) and CD4 count as surrogate markers compared to the previous generation model using only CD4 count as a surrogate marker. Validation of this model was reported previously.2 Into this valid- ated model VL and CD4 count data from the 48-week analysis of the clinical trial were inserted. The impact of resistance difference between NFV and LPV/r (33% vs. 0% observed at 48-week) was also examined.
Over the first five years, the model estimated that LPV/r could save total HIV care cost at $4,011 per patient compared with NFV, when drug resistance was not considered. If the resistance advantage of LPV/r was taken into account, the cost savings of LPV/r was increased to $6,096. For longer-term projection, without considering the resistance difference, the incremental cost effectiveness ratio for LPV/r vs. NFV was at $3,423 per quality adjusted lifeyear (QALY). This cost-effectiveness ratio is even superior to antihypertensive medication treatment ($9,500/QALY, 1998), and is a dominant strategy for health policy decision makers.
When considering treatment options, this study suggests that use of LVP/r in the first ARV regimen, as compared to NFV, appears to be cost effective based on improved efficacy and resistance.
1. Walmsley S, et al. "Lopinavir-ritonavir versus nelfinavir for the initial treatment of HIV infection", N Engl J Med 2002 Jun 27;346(26):2039-46.
2. Simpson KN, et al. 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, 2000. Abstract 2048.
Presenting author: Kit Simpson
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1 Medical University of South Carolina, Charleston, SC.
2 Abbott Laboratories, Abbott Park, IL, USA
2002-11-17
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