Monday, February 1, 2016

Cost-Effectiveness of Single- vs Generic Multiple-Tablet Regimens for Treatment of HIV-1 Infection in the U.S.

The possibility of incorporating generics into combination antiretroviral therapy and breaking apart once-daily single-tablet regimens (STRs), may result in less efficacious medications and/or more complex regimens with the expectation of marked monetary savings. A modeling approach that assesses the merits of such policies in terms of lifelong costs and health outcomes using adherence and effectiveness data from real-world U.S. settings.

A comprehensive computer-based microsimulation model was developed to assess the lifetime health (life expectancy and quality adjusted life-years-QALYs) and economic outcomes in HIV-1 infected patients initiating STRs compared with multiple-table regimens including generic medications where possible (gMTRs). The STRs considered included tenofovir disoproxil fumarate/emtricitabine and efavirenz or rilpivirine or elvitegravir/cobicistat. gMTRs substitutions included each counterpart to STRs, including generic lamivudine for emtricitabine and generic versus branded efavirenz.

Life expectancy is estimated to be 1.301 years higher (discounted 0.619 QALY gain) in HIV-1 patients initiating a single-tablet regimen in comparison to a generic-based multiple-table regimen. STRs were associated with an average increment of $26,547.43 per patient in medication and $1,824.09 in other medical costs due to longer survival which were partially offset by higher inpatients costs ($12,035.61) with gMTRs treatment. Overall, STRs presented incremental lifetime costs of $16,335.91 compared with gMTRs, resulting in an incremental cost-effectiveness ratio of $26,383.82 per QALY gained.

STRs continue to represent good value for money under contemporary cost-effectiveness thresholds despite substantial price reductions of generic medications in the U. S.

Below:  Distribution of real-world average adherence levels, stratified by first-line treatment strategy.
MTR, multiple-tablet regimen; STR, single-tablet regimen.

Below:  Hazard ratios of virologic suppression and virologic failure for different adherence classes.
VF, virological failure.

Below:  Tornado diagram of univariate analyses showing the degree to which uncertainty in individual variables affects ICER ($/QALY).
EFV, efavirenz; ICER, incremental cost-effectiveness ration; MTR, multiple-tablet regimen; QALY, quality adjusted life years; STR, single-tablet regimen.

Full article at:

  • 1Internal Medicine, The University of Kansas School of Medicine-Wichita, Wichita, Kansas, United States of America.
  • 2Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America.
  • 3CRI New England, Boston, Massachusetts, United States of America.
  • 4Exigo Consultores, Lisbon, Portugal. 
  •  2016 Jan 25;11(1):e0147821. doi: 10.1371/journal.pone.0147821. eCollection 2016.

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