%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Boyer, S.
%A Nishimwe, M. L.
%A Sagaon Teyssier, Luis
%A March, Laura
%A Koulla-Shiro, S.
%A Bousmah, M. Q.
%A Toby, R.
%A Mpoudi-Etame, M. P.
%A Gueye, N. F. N.
%A Sawadogo, A.
%A Kouanfack, C.
%A Ciaffi, L.
%A Spire, B.
%A Delaporte, E.
%T Cost-effectiveness of three alternative boosted Protease inhibitor-based second-line regimens in HIV-infected patients in West and Central Africa
%D 2020
%L fdi:010077924
%G ENG
%J Pharmacoeconomics-Open
%@ 2509-4262
%K BURKINA FASO ; CAMEROUN ; SENEGAL
%M ISI:000513273400006
%N 1
%P 45-60
%R 10.1007/s41669-019-0157-9
%U https://www.documentation.ird.fr/hor/fdi:010077924
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers20-04/010077924.pdf
%V 4
%W Horizon (IRD)
%X Background While dolutegravir has been added by WHO as a preferred second-line option for the treatment of HIV infection, boosted protease inhibitor (bPI)-based regimens are still needed as alternative second-line options. Identifying optimal bPI-based second-line combinations is essential, given associated high costs and funding constraints in low- and middle-income countries. We assessed the cost-effectiveness of three alternative bPI-based second-line regimens in Burkina Faso, Cameroon and Senegal. Methods We used data collected over 2010-2015 in the 2LADY trial/post-trial cohort. Patients with first-line antiretroviral therapy (ART) failure were randomly assigned to tenofovir/emtricitabine + lopinavir/ritonavir (TDF/FTC LPV/r; arm A), abacavir + didanosine + lopinavir/ritonavir (arm B), or tenofovir/emtricitabine + darunavir/ritonavir (arm C). Costs (US dollars, 2016), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios were computed for each country over 24 months of follow-up and extrapolated to 5 years using a simulated patient-level Markov model. We assessed uncertainty using cost-effectiveness acceptability curves, scenarios and prices threshold analysis. Results In each country, over 24 months, arm A was significantly less costly than arms B and C (incremental costs ranging from US$410-$US721 and US$468-US$546 for B and C vs A, respectively) and offered similar health benefits (incremental QALY: - 0.138 to 0.023 and - 0.179 to 0.028, respectively). Over 5 years, arm A remained the least costly, health benefits not being significantly different between arms. Compared with arms B and C, in each study country, Arm A had a >= 95% probability of being cost-effective for a large range of cost-effectiveness thresholds, irrespective of the scenario considered. Conclusions Using TDF/FTC LPV/r as a bPI-based second-line regimen provided the best economic value in the three study countries.
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