Cost-effectiveness of three alternative boosted Protease inhibitor-based second-line regimens in HIV-infected patients in West and Central Africa Boyer, S. Nishimwe, M. L. /Sagaon Teyssier, Luis /March, Laura Koulla-Shiro, S. Bousmah, M. Q. Toby, R. Mpoudi-Etame, M. P. Gueye, N. F. N. Sawadogo, A. Kouanfack, C. Ciaffi, L. Spire, B. Delaporte, E. 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. 2020 text https://www.documentation.ird.fr/hor/fdi:010077924 fdi:010077924 Boyer S., Nishimwe M. L., Sagaon Teyssier Luis, March Laura, Koulla-Shiro S., Bousmah M. Q., Toby R., Mpoudi-Etame M. P., Gueye N. F. N., Sawadogo A., Kouanfack C., Ciaffi L., Spire B., Delaporte E.. Cost-effectiveness of three alternative boosted Protease inhibitor-based second-line regimens in HIV-infected patients in West and Central Africa. 2020, 4 (1), 45-60 EN BURKINA FASO CAMEROUN SENEGAL