Cost effectiveness analysis of abacavirlamivudine versus tenofoviremtricitabine combination therapy as part of highly active antiretroviral therapy in treatment naive HIV-infected patients

Abstract

Introduction: Current recommendations for the treatment of HIV include the use of dual nucleoside reverse transcriptase inhibitors, namely abacavir/lamivudine or tenofovir/emtricitabine. This study is to compare the cost-effectiveness of these two alternatives in the treatment of HIV treatment-naive patients. Methods: A review of the literature was performed to identify relevant randomized controlled trials and economic models. The economic model described by Richter using maximal virologic response and rate of failure as efficacy parameters was adapted to take into consideration the effect of HLA-B*5701 genotyping. Indirect comparison technique was used to ascertain the estimate of efficacy parameters. Sensitivity analyses were performed on costs, efficacy parameters and utilities. Results: Abacavir/lamivudine was dominant over tenofovir/emtricitabine. Efficacy parameters, but not costs and utilities, was very sensitive with a small variation leading to tenofovir/emtricitabine dominance. Conclusion: Abacavir/lamivudine is dominant over tenofovir/emtricitabine in treatment-naive HIV-infected patients. Results are extremely sensitive to efficacy parameters.