The efficacy of a regimen and its durability, as demonstrated in controlled clinical trials, must be considered in the light of short- and long-term economic impacts on the healthcare system. These impacts may vary based on drug costs, costs of managing adverse events, the regimen's likelihood of contributing to viral resistance to second-line therapies, and the marginal cost differences between other healthcare resources used over a patient's lifetime.

Risk of coronary heart disease (CHD) may be of concern in the selection of antiretroviral therapy because differences in CHD risk factors have been reported for different regimens, and heart disease is both a deadly and a costly condition.

In the current study, published in Clinical Drug Investigation, the authors aimed to estimate the long-term combined effects of HIV disease and antiretroviral-related risk for CHD on quality-adjusted survival and healthcare costs for antiretroviral-experienced patients in the UK, Spain, Italy, and France.

A previously validated Markov model was updated with 2006 cost estimates for each of the 4 countries, and supplemented with the Framingham CHD risk equation. In the model, the average patient was male, aged 37 years, with a baseline 10-year CHD risk of 4.6%.

Patients started regimens containing either lopinavir/ritonavir (Kaletra) or ritonavir-boosted atazanavir (Reyataz/r) as the protease inhibitor (PI). Clinical trial results, local drug costs, and AIDS and CHD cost estimates were used to estimate the differences between these 2 therapies.

Studies have shown that atazanavir is associated with fewer blood lipid abnormalities than lopinavir/ritonavir and other PIs, thus it may reduce cardiovascular risk.

Results

Conclusion

Based on their findings, the authors concluded the following:

Medical University of South Carolina, Charleston, South Carolina, USA.

11/27/07

Reference
KN Simpson, WJ Jones, R Rajagopalan, and others. Cost Effectiveness of Lopinavir/Ritonavir Tablets Compared with Atazanavir plus Ritonavir in Antiretroviral-Experienced Patients in the UK, France, Italy and Spain. Clinical Drug Investigation 27(12): 807-817. 2007.