OBJECTIVES: To assess the average per-person 96-week HIV treatment costs associated with the three comparators examined in the ACTG 5257 clinical trial, raltegravir (RAL), atazanavir/ritonavir (ATV/r), or darunavir/ritonavir (DRV/r), when used in combination with tenofovir DF/emtricitabine (TDF/FTC), for treatment-naive adults with HIV-1 infection in the United States (US).
METHODS: An economic model was developed to estimate costs for antiretroviral drugs, adverse event management, and HIV care for individuals initiating first-line therapy. Head-to-head efficacy and safety data (discontinuation rates, mean CD4+ cell-count changes, adverse event incidence) up to 96 weeks for RAL, ATV/r, and DRV/r were obtained from the ACTG 5257 clinical trial. Antiretroviral drug costs were based on wholesale acquisition costs. Adverse event management costs and HIV care costs, stratified by CD4+cellcount range, were obtained from published sources and inflated to 2014 US dollars. Outcomes were discounted at 3.0% per year. Probabilistic sensitivity analysis (PSA) and scenario analyses were conducted.
RESULTS: At 96 weeks, RAL was associated with lower antiretroviral drug costs and adverse event costs and similar HIV care costs when compared with either ATV/r or DRV/r. Total costs were $70,121 for RAL, $76,829 for ATV/r, and $76,148 for DRV/r. The PSA showed that the 95% confidence interval for the mean total cost of RAL was lower than and did not overlap with those of ATV/r or DRV/r. Scenario analyses found RAL to have the lowest cost over a range of modeling assumptions.
CONCLUSIONS: RAL has the lowest per-person cost compared with two other common first-line regimens, DRV/r and ATV/r, each used in combination with TDF/FTC, for treatment-naive adults with HIV-1 infection in the US. These results were found to be robust in sensitivity and scenario analyses. This economic evidence further complements the known clinical benefits of RAL as reported in the ACTG 5257 clinical trial.
