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A Review of Economic Evaluations of Darunavir Boosted by Low-Dose Ritonavir in Treatment-Experienced Persons Living with HIV Infection

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Abstract

Darunavir boosted by low-dose ritonavir (DRV/r), at a daily dose of 600/100mg twice a day (bid), has been shown to be superior to alternative highly active antiretroviral therapy (HAART) regimens for the management of treatment-experienced, HIV-infected adults in the phase IIb POWER trials and the phase III TITAN trial.

Economic analyses of different types that have been performed for several countries to investigate the cost effectiveness and budgetary impact of DRV/r 600/100mg bid for treatment-experienced people living with HIV (PLHIV) based on the clinical data gathered in the POWER and TITAN trials are reviewed for consistency and their value to different decision-makers is assessed.

Cost-utility analyses for the USA and several European countries indicate that DRV/r-based HAART is cost effective compared with other standard of care protease inhibitor (PI)-based regimens in PLHIV with evidence of PI resistance. For all of these countries, the estimated cost-utility ratio is well below typical benchmark values and these ratios are robust, as demonstrated by one-way sensitivity and variability analyses and multi-way probabilistic sensitivity analyses.

Studies using other metrics including the average 1-year drug cost per patient with a plasma HIV-RNA level less than 50 copies/mL at 48 weeks, the incremental drug cost per additional patient with a plasma HIV-RNA level less than 50 copies/mL at 48 weeks, the total (antiretroviral and nonantiretroviral) costs during the first year of treatment, and the total healthcare budget impact during the first 5 years of treatment provided further evidence of the positive economic outcomes with the use ofDRV/r in treatmentexperienced PLHIV.

Different measures of economic outcomes are useful for different types of decision-makers and different types of decisions. In general, the results of these different types of analyses will be consistent with each other. For darunavir, the economic analyses reviewed in this paper demonstrate that the use of DRV/r 600/100mg bid in the management of HIV-infected, treatmentexperienced adults who have failed at least one of the other currently available PIs is cost effective and may be cost saving.

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Acknowledgements

The authors wish to thank Tony Vangeneugden, Ben Van Baelen, Els De Paepe, Alain Smits, Eric Lefebvre, Sabrina Spinosa-Guzman, Frank Tomaka, Frederic Godderis, Piet De Doncker, Martine De Pauw and the rest of the darunavir study team at Tibotec Pharmaceuticals, Mechelen, Belgium, for their contributions in analyzing and generating the clinical trial data that supported the above-mentioned economic analyses. Special thanks also go to all the co-authors of the papers included in the Darunavir PharmacoEconomics Supplement. The authors also acknowledge Catherine Elliott (medical writer, Gardiner-Caldwell Communications, Macclesfield, UK) for her editorial support. Last but not least, the authors wish to thank all the study investigators, the PLHIV and their families for their (past, current and future) participation and support in the (further) clinical development of darunavir. This project was financially supported by Johnson & Johnson Pharmaceutical Services.

JM has received grant support from Janssen Cilag, the manufacturer of darunavir, to assist with the preparation of this manuscript. JM was not restricted by Janssen Cilag in her interpretation of the individual papers on which the review was based. LA has received consulting fees from Johnson & Johnson. AH has received consultancy payments from Tibotec to work on the health economics of darunavir. ES is an employee of Johnson & Johnson Pharmaceutical Services, Beerse, Belgium, and owns stock options and shares in this company.

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Authors and Affiliations

  1. RTI Health Solutions, Research Triangle Park, 12194, 27709-2194, 3040 Cornwallis Road, NC, USA

    Josephine Mauskopf

  2. Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Lieven Annemans

  3. Department of Pharmacology, University of Liverpool, Liverpool, UK

    Andrew M. Hill

  4. Tibotec Pharmaceuticals BVBA, Mechelen, Belgium

    Andrew M. Hill

  5. Johnson & Johnson Pharmaceutical Services LLC, Mechelen, Belgium

    Erik Smets

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Correspondence to Josephine Mauskopf.

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Mauskopf, J., Annemans, L., Hill, A.M. et al. A Review of Economic Evaluations of Darunavir Boosted by Low-Dose Ritonavir in Treatment-Experienced Persons Living with HIV Infection. Pharmacoeconomics 28 (Suppl 1), 1–16 (2010). https://doi.org/10.2165/11587410-000000000-00000

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