%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Bousmah, Marwan-al-Qays
%A Nishimwe, M.L.
%A Tovar-Sanchez, T.
%A Wandji, M.L.
%A Mpoudi-Etame, M.
%A Maradan, G.
%A Bassega, P.O.
%A Varloteaux, M.
%A Montoyo, A.
%A Kouanfack, C.
%A Delaporte, E.
%A Boyer, Sylvie
%T 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)
%D 2021
%L fdi:010089016
%G ENG
%J Pharmaceconomics
%@ 1170-7690
%K CAMEROUN
%M ISI:000601477200001
%N 3
%P 331-343
%R 10.1007/s40273-020-00987-3
%U https://www.documentation.ird.fr/hor/fdi:010089016
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2023-12/010089016.pdf
%V 39
%W Horizon (IRD)
%X 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 $4.7/month) would increase its cost-effectiveness probability to 95%. When extrapolating outcomes over 5 and 10 years, the DTG-based regimen had a 100% probability of being cost-effective for a large range of cost-effectiveness thresholds. Conclusions At 2020 antiretroviral drug prices, a DTG-based first-line regimen should be preferred over an EFV400-based regimen in sub-Saharan Africa.
%$ 052MALTRA03 ; 050MEDECI ; 094COMIN