Cost-utility analysis of a Dolutegravir-based versus low-dose Efavirenz-based regimen for the initial treatment of HIV-infected patients in Cameroon (NAMSAL ANRS 12313 Trial)

2021

Article référencé dans le Web of Science WOS:000601477200001

Bousmah Marwan-al-Qays, Nishimwe M.L., Tovar-Sanchez T., Wandji M.L., Mpoudi-Etame M., Maradan G., Bassega P.O., Varloteaux M., Montoyo A., Kouanfack C., Delaporte E., Boyer Sylvie

Pharmaceconomics, 2021, 39 (3), 331-343 ISSN 1170-7690

Objectives Evidence comparing the economic and patient values of the World Health Organization's preferred (dolutegravir 50 mg [DTG]-based) and alternative (low-dose [400 mg] efavirenz [EFV400]-based) first-line antiretroviral regimens is limited. We compared patient-reported outcomes (PROs), costs, and the cost-utility of DTG- versus EFV400-based regimens in treatment-naive HIV-1 adults in the randomised NAMSAL ANRS 12313 trial in Yaounde, Cameroon. Methods We used clinical data, PROs, and health resource use data collected in the trial's first 96 weeks (2016-2019). Quality-adjusted life-years (QALYs) were computed using utility scores obtained from the 12-item Short Form (SF-12) generic health scale. Other PROs included perceived symptoms, depression, anxiety, and stress. In the 96-week base-case analysis, we estimated the unadjusted and multivariate-adjusted (1) mean costs (in US, 2016 values) and QALYs/patient, (2) incremental costs and QALYs/patient, and (3) net health benefit (NHB). Outcomes were extrapolated over 5 and 10 years. Uncertainty was assessed using the cost-effectiveness acceptability curve and scenario and cost-effective price threshold analyses. Results In the base-case analysis, the NHB (95% confidence interval) for the DTG-based regimen relative to the EFV400-based regimen was 0.056 (- 0.037 to 0.153), corresponding to an 88% probability of DTG being cost-effective. A 10% decrease in this regimen's price (from 5.2 to 4.7/month) would increase its cost-effectiveness probability to 95%. When extrapolating outcomes over 5 and 10 years, the DTG-based regimen had a 100% probability of being cost-effective for a large range of cost-effectiveness thresholds. Conclusions At 2020 antiretroviral drug prices, a DTG-based first-line regimen should be preferred over an EFV400-based regimen in sub-Saharan Africa.

Médecine [050MEDECI] ; Maladies sexuellement transmissibles [052MALTRA03] ; Relations économiques internationales [094COMIN]

Fonds IRD [F B010089016]

fdi:010089016