Cost and cost-effectiveness of switching from stavudine to tenofovir in first-line antiretroviral regimens in South Africa
Cost and cost-effectiveness of switching from stavudine to tenofovir in first-line antiretroviral regimens in South Africa
复制标题
DOI：
10.1097/qai.0b013e31817ae5ef
复制
发表时间：
2008-07-01
影响因子：
3.6
通讯作者：
Sanne, Ian
中科院分区：
文献类型：
--
作者：
Rosen, Sydney;Long, Lawrence;Sanne, Ian
背景：非洲大多数一线抗逆转录病毒治疗方案包括司他夫定 (d4T)，尽管与之相关的毒性发生率很高。我们估计。南非从 d4T 转换为富马酸替诺福韦二吡呋酯 (TDF) 的成本和成本效益。方法：开发了一个模型来估计假设队列中在抗逆转录病毒治疗开始后 2 年内经历过 d4T 和 TDF 相关事件的患者比例。转变概率、事件和药物成本以及效用损失是根据原始数据和文献估计的。结果包括增量成本、每个质量调整生命年的增量成本效益比以及 TDE 结果的阈值价格：2 年后，82.5% 的 d4T 方案队列仍继续使用 d4T，16.6% 已改用 AZT，0.8% 死亡，并且发生了 414 起未导致药物变更的事件。在 TDF 方案中，97.5% 的人群仍使用 TDE，TDF 的基准成本为每月 17.00 美元。 TDF 方案的增量成本为每患者每年 128 美元，每增加质量调整生命年，增量成本效益比为 9007 美元。以 6.17 美元/月的价格，对 TDF 的变更对政府来说成本中性，以 12.94 美元/月的价格高度划算。 结论：以 17.00 美元/月的 TDF 价格计算，d4T 毒性管理节省将抵消 TDE 较高价格的约 20%。 TDF 的价格必须大幅下降，才能使南非预算方面的变更成本中性，但仅以价格计算就具有高度成本效益。比目前可用的略少。
Background: Most first-line antiretroviral therapy regimens in Africa include stavudine (d4T), despite the high incidence of toxicities related to it. We estimated. the cost and cost-effectiveness of switching from d4T to tenofovir disoproxil fumarate (TDF) in South Africa.Methods: A model was developed to estimate the proportion of patients in a hypothetical cohort who experienced d4T- and TDF-related events over the 2 years after antiretroviral therapy initiation. Transition probabilities, event and drug costs, and utility losses were estimated from primary data and the literature. Outcomes included incremental cost, incremental cost-effectiveness ratio per quality-adjusted life year gained, and threshold prices for TDEResults: After 2 years, 82.5% of the d4T scenario cohort remained on d4T, 16.6% had switched to AZT, 0.8% had died, and 414 events that did not lead to a drug change had occurred. In the TDF scenario, 97.5% of the cohort remained on TDE At a baseline cost of TDF of $17.00/month. the incremental cost of the TDF scenario was $128/patient/year and the incremental cost-effectiveness ratio was $9007 per quality-adjusted life year gained. The change to TDF would be cost neutral for the government at a price of $6.17/month and highly cost effective at a price of $12.94/month.,Conclusions: At a TDF price of $17.00/month, savings on d4T toxicity management will offset roughly 20% of the higher price of TDE The price of TDF would have to fall substantially to make the change cost neutral for South Africa in budgetary terms, but it would be highly cost effective at a price only slightly less than what is currently available.