Economic
and Clinical Impact of Using Atazanavir + Ritonavir versus Lopinavir/Ritonavir
 Choosing
an anti-HIV regimen is complicated because of the necessity to balance a variety
of factors. These include the risk of adverse events, resistance concerns, and
the cost of treatment.
The
current analysis by researchers at Abbott Laboratories and the Medical University
of South Carolina, Charleston, SC, estimates the long-term combined effects of
HIV-disease and ARV-related risk for coronary heart disease (CHD) on quality-adjusted
survival and health care costs in ARV-experienced patients. A
previously developed lopinavir/ritonavir
(Kaletra) economic model used total cholesterol levels to predict myocardial
infarcts and deaths based on the Framingham equation. For
this analysis the model was populated with the proportion of patients with serum
HIV-1 RNA below 400 and below 50 copies/mL, and the cholesterol levels reported
for the comparison of atazanavir
(Reyataz) + ritonavir (Norvir)
and lopinavir/ritonavir (Kaletra)
in BMS study 045 (CROI poster # J33 547). The
model estimated the long-term combined effects of HIV-disease and ARV-related
risk for CHD on quality-adjusted survival and health care costs. Results 
An ARV-experienced patient, similar to patients included in the BMS045 study,
would be expected to gain 4.6 quality-adjusted months (net gain after correcting
for differences in coronary heart disease risk) of survival if treated with lopinavir/ritonavir
instead of atazanavir + ritonavir.
Total health care cost savings of $12,283 during the first five years of therapy
and $14,118 over the initial 10 years of treatment would be expected for patients
on a lopinavir/ritonavir-based regimen.
Lifetime savings of $3,600 (which incorporates the additional costs of longer
survival for lopinavir/ritonavir-treated patients) would be expected.
Based
on these results, the authors conclude, "The model predicts that a lopinavir/ritonavir-based
regimen is both clinically and economically superior to a regimen using atazanavir
+ ritonavir regimen in ARV-experienced patients." "The
survival benefit is due to the differences in the proportion of patients with
serum HIV-1 RNA below 50 copies/mL." "The
economic benefit is due to both the lower cost of lopinavir/ritonavir and the
cost savings incurred by slower disease progression to costly health states." Medical
University of South Carolina, Center for Health Economics and Policy Studies,
Charleston, United States, Abbott Laboratories, Global Health Economics &
Outcomes Research, Abbott Park, United States. 08/25/06 Reference
 K
N Simpson and G E MacKinnon. Economic and
clinical impact of using a protease inhibitor regimen containing atazanavir +
ritonavir vs. lopinavir/ritonavir in antiretroviral (ARV) experienced patients:
modeling the lifetime impacts of the 48 week results from BMS AI424-045. 16th
International AIDS Conference. August 13-18, 2006. Toronto, Canada. Abstract TUPE0072. 
| 
