Predicting Direct Costs of HIV Care During the First Year of Darunavir-Based Highly Active Antiretroviral Therapy Using CD4 Cell Counts Evidence from POWER

• Published in: PharmacoEconomics Vol. 28; no. Suppl 1; pp. 169 - 181
• Main Authors: Hill, Andrew M., Gebo, Kelly, Hemmett, Lindsay, Löthgren, Mickael, Allegri, Gabriele, Smets, Erik
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.01.2010; Adis International; Springer Healthcare | Adis; Springer Nature B.V
• Series: PharmacoEconomics
• Subjects: Acquired immune deficiency syndrome; Adult; Aged; Aged, 80 and over; AIDS; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - economics; Antiretrovirals; Antiviral agents; Biological and medical sciences; CD4 Lymphocyte Count - economics; Clinical Trials, Phase II as Topic; Cost-analysis; Costs; Darunavir; Drug Costs; Drug dosages; Drug therapy; Europe; Health Administration; Health Care Costs; Health Economics; Health services; Health technology assessment; HIV; HIV Infections - drug therapy; HIV Infections - economics; HIV Protease Inhibitors - economics; HIV Protease Inhibitors - therapeutic use; HIV-1; HIV-infections; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multicenter Studies as Topic; Original Research Article; Patients; Peptide-hydrolase-inhibitors; Pharmacoeconomics and Health Outcomes; Pharmacology. Drug treatments; Public Health; Quality of Life Research; Randomized Controlled Trials as Topic; Ritonavir; Ritonavir - economics; Ritonavir - therapeutic use; Sulfonamides - economics; Sulfonamides - therapeutic use; therapeutic use; treatment; United States; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; United States; Europe; Darunavir; Enfuvirtide; Healthcare Setting; Optimize Background Regimen; Etravirine; Human; Immunopathology; Antiretroviral agent; Costs; CD4 T lymphocyte; Prediction; Retroviridae; Non peptide compound; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Numeration; Treatment; Viral disease; Health economy; T-Lymphocyte; Antiviral; Human immunodeficiency virus; Protease inhibitor; Public health
• ISSN: 1170-7690; 1179-2027
• DOI: 10.2165/11587510-000000000-00000

Background : Given the association between CD4 cell counts and HIV-related morbidity/mortality, new antiretroviral therapies could potentially lower the direct costs of HIV care by raising CD4 cell counts. Objectives : To predict the effects of the ritonavir-boosted, HIV protease inhibitor (PI) darunavir on the direct costs of care, while accounting for CD4 cell counts, during the first year of therapy in highly treatment-experienced, HIV-infected adults in different healthcare settings. Methods : The mean annual per-patient cost of darunavir/ritonavir (DRV/r) and control PI-based highly active antiretroviral therapy (HAART) was calculated from the proportional use of antiretroviral agents in the DRV/r and control PI arms of the pooled POWER 1 and 2 trials, applying drugacquisition costs for five healthcare settings. Non-antiretroviral-related costs by CD4 cell count, derived from non-interventional studies in the same settings, were applied to the POWER data (proportion of patients with CD4 cell counts in different strata at week 48) to estimate mean annual nonantiretroviral-related costs per patient in patients receiving DRV/r or control PI-based HAART during year 1. Results : Across all settings, the mean annual per-patient cost of DRV/r-based treatment was 2–19% higher than that of control PI-based therapy during the first year of therapy. By raising CD4 cell counts, however, DRV/r-based regimens were predicted to lower mean annual non-antiretroviral-related costs by 16–38% compared with control PI-based therapy. When combined, the total annual per-patient cost of HIV care during the first year of therapy was estimated to be 7%lower in the DRV/r compared with the control PI arm using US data, 8% lower using Swedish data, budget neutral using UK and Belgian data and 5% higher using Italian data. Conclusions : Darunavir-based HAART may lower non-antiretroviral-related costs comparedwith control PI-based therapy in highly treatment-experienced, HIV-infected patients during the first year of therapy by improving patients CD4 cell counts. These costs could partly/fully offset the increased acquisition cost of DRV/r in this patient population over the same period.