PharmacoEconomics

, Volume 19, Issue 1, pp 95–104

Economic Analysis of Initial HIV Treatment

Efavirenz- versus Indinavir-Containing Triple Therapy
  • J. Jaime Caro
  • Judith A. O’Brien
  • Kristen Migliaccio-Walle
  • Gabriel Raggio
Original Research Article

DOI: 10.2165/00019053-200119010-00007

Cite this article as:
Caro, J.J., O’Brien, J.A., Migliaccio-Walle, K. et al. Pharmacoeconomics (2001) 19: 95. doi:10.2165/00019053-200119010-00007

Abstract

Objective: To compare the clinical and economic outcomes associated with triple therapy containing efavirenz or indinavir and 2 nucleoside reverse transcriptase inhibitors (NRTIs; zidovudine and lamivudine) in HIV-positive patients.

Design and setting: An economic model based on viral load and CD4+ cell counts to predict long term outcomes such as progression to AIDS and AIDS-related death was developed and then analysed using data from a randomised clinical trial. Cost estimates from the healthcare system perspective were based on data from 6 state, all-payor databases, the AIDS Cost and Services Utilisation Study, and other literature. Analyses were carried out for time horizons between 5 and 15 years.

Patients and interventions: HIV-positive patients with limited exposure to NRTIs. Initial regimens consisted of efavirenz or indinavir, each combined with 2 NRTIs. A maximum of 2 switches to other regimens was permitted.

Main outcome measures and results: The efavirenz-containing triple therapy regimen was predicted to prolong survival at a savings of up to 10 923 US dollars (1998 values) relative to initial therapy with the indinavir-containing regimen. Patients who receive efavirenz are expected to have 11% greater survival at 5 years and fewer treatment failures (28 vs 52%, at 2 years). Overall, the economic and health benefits predicted for the efavirenz-containing regimen were robust to reasonable variation in key parameters.

Conclusions: The superior clinical trial outcomes for efavirenz-containing regimens should translate into substantial economic and health benefits.

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  • J. Jaime Caro
    • 1
    • 2
  • Judith A. O’Brien
    • 1
  • Kristen Migliaccio-Walle
    • 1
  • Gabriel Raggio
    • 1
  1. 1.Caro ResearchConcordUSA
  2. 2.Division of General Internal Medicine, Royal Victoria HospitalMcGill UniversityMontrealCanada
  3. 3.ConcordUSA

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