Boyer S. auteur aut IRD Nishimwe M. L. auteur aut IRD Sagaon Teyssier Luis auteur aut IRD March Laura auteur aut IRD Koulla-Shiro S. auteur aut IRD Bousmah M. Q. auteur aut IRD Toby R. auteur aut IRD Mpoudi-Etame M. P. auteur aut IRD Gueye N. F. N. auteur aut IRD Sawadogo A. auteur aut IRD Kouanfack C. auteur aut IRD Ciaffi L. auteur aut IRD Spire B. auteur aut IRD Delaporte E. auteur aut IRD text journalArticle eng text/pdf reformatted digital access 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. specialized BURKINA FASO CAMEROUN SENEGAL 056 4 1 45-60 2020 2509-4262 https://www.documentation.ird.fr/hor/fdi:010077924 10.1007/s41669-019-0157-9 2509-4262 [F B010077924] https://www.documentation.ird.fr/hor/fdi:010077924 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers20-04/010077924.pdf IRD - Base Horizon / Pleins textes 2020-05-18 2025-02-24 fdi:010077924 fre