TY - JOUR
T1 - Predicting direct costs of HIV care during the first year of darunavir-based highly active antiretroviral therapy using CD4 cell counts
T2 - Evidence from POWER
AU - Hill, Andrew M.
AU - Gebo, Kelly
AU - Hemmett, Lindsay
AU - Löthgren, Mickael
AU - Allegri, Gabriele
AU - Smets, Erik
N1 - Funding Information:
The authors are grateful to Tony Vangeneugden, Ben Van Baelen, Eric Lefebvre, Sabrina Spinosa-Guzman, Frank Tomaka, Piet De Doncker and the rest of the darunavir study team for their contributions. They also acknowledge Patrick Hoggard and Caroline Waterhouse (editorial team leader and senior editorial assistant, Gardiner-Caldwell Communications, Macclesfield, UK) for their editorial support. Finally, the authors wish to thank the study investigators, the patients and their families for their participation and support during the POWER trials. This project was financially supported by Johnson & Johnson Pharmaceutical Services.
PY - 2010
Y1 - 2010
N2 - 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.
AB - 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.
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U2 - 10.2165/11587510-000000000-00000
DO - 10.2165/11587510-000000000-00000
M3 - Article
C2 - 21182350
AN - SCOPUS:78650726135
SN - 1170-7690
VL - 28
SP - 169
EP - 181
JO - PharmacoEconomics
JF - PharmacoEconomics
IS - SUPPL. 1
ER -