TITLE

The Clinical Role and Cost-Effectiveness of Long-Acting Antiretroviral Therapy

AUTHOR(S)
Ross, Eric L.; Weinstein, Milton C.; Schackman, Bruce R.; Sax, Paul E.; Paltiel, A. David; Walensky, Rochelle P.; Freedberg, Kenneth A.; Losina, Elena
PUB. DATE
April 2015
SOURCE
Clinical Infectious Diseases;Apr2015, Vol. 60 Issue 7, p1102
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background. Long-acting antiretroviral therapy (LA-ART) is currently under development and could improve outcomes for human immunodeficiency virus (HIV)-infected individuals with poor daily ART adherence. Methods. We used a computer simulation model to evaluate the cost-effectiveness of 3 LA-ART strategies vs daily oral ART for all: (1) LA-ART for patients with multiple ART failures; (2) second-line LA-ART for those failing first-line therapy; and (3) first-line LA-ART for ART-naive patients. We calculated the maximum annual cost of LAART at which each strategy would be cost-effective at a willingness to pay of $100 000 per quality-adjusted life-year. We assumed HIV RNA suppression on daily ART ranged from 0% to 91% depending on adherence, vs 91% suppression on LA-ART regardless of daily ART adherence. In sensitivity analyses, we varied adherence, efficacy of LAART and daily ART, and loss to follow-up. Results. Relative to daily ART, LA-ART increased overall life expectancy by 0.15-0.24 years, and by 0.51-0.89 years among poorly adherent patients, depending on the LA-ART strategy. LA-ART after multiple failures became cost-effective at an annual drug cost of $48 000; in sensitivity analysis, this threshold varied from $40 000-$70 000. Second-line LA-ART and first-line LA-ART became cost-effective at an annual drug cost of $26 000-$31 000 and $24 000-$27 000, vs $28 000 and $25 000 for current second-line and first-line regimens. Conclusions. LA-ART could improve survival of HIV patients, especially those with poor daily ART adherence. At an annual cost of $40 000-$70 000, LA-ART will offer good value for patients with multiple prior failures. To be a viable option for first-or second-line therapy, however, its cost must approach that of currently available regimens.
ACCESSION #
101901047

 

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