Cost Effectiveness of Truvada versus Combivir, Both in Combination with Efavirenz (Sustiva)

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The objective of the current study, published in the February 2008 issue of Clinical Therapy, was to compare 2 HAART regimens using fixed-dose combination pills in antiretroviral-naïve patients:

• tenofovir/emtricitabine (Truvada) + efavirenz (Sustiva) and

• lamivudine/zidovudine (Combivir) + efavirenz (Sustiva)

The investigators aimed to compare the cost per unit of effectiveness (successful treatment) of the regimens from the perspective of costs to society.

Truvada Pill

Combivir Pill

Sustiva Pill

This cost-effectiveness analysis was modeled using a decision tree that considered therapeutic response (successful treatment episode, i.e., HIV RNA < 400 copies/mL using data obtained directly from a clinical trial) and the switch to rescue therapy in non-responders. The time horizon was 24 months of treatment.

Cost was defined as direct medical costs (drugs, diagnostic and/or laboratory tests, treatment of adverse effects) and indirect medical costs (productivity losses). All data are presented as Euro values in 2005 (currently 1 Euro = U.S. $1.6).

Sensitivity analysis was 1-factor threshold, adjustment of ex-factory cost, only direct costs, and applying a discount rate in the study. Results are presented as incremental costs, success rates, and cost per patient with undetectable viral load or additional success.

Results

• The 48-week cost was 46,464 Euro for the Truvada/efavirenz regimen, versus 56,198 Euro for the Combivir/efavirenz regimen.

• Therefore, savings of 9734 Euro were achieved for each patient treated with Truvada/efavirenz.

• This regimen also produced a gain of 13% of patients with undetectable viral load after 24 months of treatment.

• Consequently, treatment with the Truvada/efavirenz combination would be dominant in therapy for antiretroviral-naive HIV patients.

• Sensitivity tests supported the stability of the base-case analysis.

• The cost-effectiveness ratios were 619.52 Euro for the Truvada/efavirenz regimen versus 906.41 Euro for the Combivir/efavirenz regimen.

Conclusion

Based on these findings, the study authors wrote, "Patients who started treatment of HIV-1 infection with combination Truvada + efavirenz had significantly lower health care resource utilization and overall treatment costs compared with the Combivir + efavirnez combination."

Gilead Sciences Inc., Madrid, Spain.

3/28/08

Reference
R Sanchez-de la Rosa, L Herrera L, S Moreno, and others. Cost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients. Clinical Therapy 30(2): 372-381. February 2008.