Cost-effectiveness of antiretroviral regimens in the World Health Organization's treatment guidelines: a South African analysis
Cost-effectiveness of antiretroviral regimens in the World Health Organization's treatment guidelines: a South African analysis
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DOI：
10.1097/qad.0b013e328340fdf8
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发表时间：
2011-01-01
期刊：
影响因子：
3.8
通讯作者：
Zolopa, Andrew
中科院分区：
文献类型：
--
作者：
Bendavid, Eran;Grant, Philip;Zolopa, Andrew
目标：世界卫生组织（世卫组织）最近修改了其在资源有限情况下的一线抗逆转录病毒治疗准则。新的指南的成本效益是unknown.Design：比较有效性和成本效益分析，使用一个模型的HIV疾病进展和treatment.Methods：使用模拟的HIV疾病和治疗在南非，我们比较了预期寿命，质量调整后的预期寿命，终身成本，和成本效益的五个初始方案。世卫组织目前推荐的有四种：替诺福韦/拉米夫定/依法韦仑;替诺福韦/拉米夫定/奈韦拉平;齐多夫定/拉米夫定/依法韦仑;齐多夫定/拉米夫定/奈韦拉平。第五种是目前用途：司他夫定/拉米夫定/奈韦拉平。病毒抑制和毒性决定了方案的有效性和成本效益。结果：一线方案的选择与近12个月的质量调整预期寿命差异相关，从135.2个月（替诺福韦/拉米夫定/依法韦仑）到123.7个月（司他夫定/拉米夫定/奈韦拉平）。司他夫定/拉米夫定/奈韦拉平比齐多夫定/拉米夫定/奈韦拉平更昂贵，效果更差。与齐多夫定/拉米夫定/奈韦拉平相比，使用含替诺福韦/拉米夫定/奈韦拉平的方案开始治疗，每质量调整生命年的成本-效果比增加1045美元。与替诺福韦/拉米夫定/奈韦拉平相比，使用替诺福韦/拉米夫定/依法韦仑与最高的生存率、最少的机会性疾病、最低的方案替代率以及每质量调整生命年5949美元的增量成本效果比相关。齐多夫定/拉米夫定/依法韦仑比替诺福韦/拉米夫定/奈韦拉平更昂贵，效果更差。结果是敏感的毒性和disutility与每个toxics.Conclusion：WHO推荐的选项中，我们估计只有三个应该考虑在正常情况下的利率。在这些方案中作出选择取决于现有资源和支付意愿。与齐多夫定/拉米夫定/奈韦拉平相比，司他夫定/拉米夫定/奈韦拉平与最差的质量调整生存率和更高的费用相关。(C)2011威科健康垂直酒吧Lippincott威廉姆斯& Wilkins
Objective: The World Health Organization (WHO) recently changed its first-line antiretroviral treatment guidelines in resource-limited settings. The cost-effectiveness of the new guidelines is unknown.Design: Comparative effectiveness and cost-effectiveness analysis using a model of HIV disease progression and treatment.Methods: Using a simulation of HIV disease and treatment in South Africa, we compared the life expectancy, quality-adjusted life expectancy, lifetime costs, and cost-effectiveness of five initial regimens. Four are currently recommended by the WHO: tenofovir/lamivudine/efavirenz; tenofovir/lamivudine/nevirapine; zidovudine/lamivudine/efavirenz; and zidovudine/lamivudine/nevirapine. The fifth is the most common regimen in current use: stavudine/lamivudine/nevirapine. Virologic suppression and toxicities determine regimen effectiveness and cost-effectiveness.Results: Choice of first-line regimen is associated with a difference of nearly 12 months of quality-adjusted life expectancy, from 135.2 months (tenofovir/lamivudine/efavirenz) to 123.7 months (stavudine/lamivudine/nevirapine). Stavudine/lamivudine/nevirapine is more costly and less effective than zidovudine/lamivudine/nevirapine. Initiating treatment with a regimen containing tenofovir/lamivudine/nevirapine is associated with an incremental cost-effectiveness ratio of $1045 per quality-adjusted life year compared with zidovudine/lamivudine/nevirapine. Using tenofovir/lamivudine/efavirenz was associated with the highest survival, fewest opportunistic diseases, lowest rate of regimen substitution, and an incremental cost-effectiveness ratio of $5949 per quality-adjusted life year gained compared with tenofovir/lamivudine/nevirapine. Zidovudine/lamivudine/efavirenz was more costly and less effective than tenofovir/lamivudine/nevirapine. Results were sensitive to the rates of toxicities and the disutility associated with each toxicity.Conclusion: Among the options recommended by WHO, we estimate only three should be considered under normal circumstances. Choice among those depends on available resources and willingness to pay. Stavudine/lamivudine/nevirapine is associated with the poorest quality-adjusted survival and higher costs than zidovudine/lamivudine/nevirapine. (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins