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Costs to Achieve Undetectable HIV RNA with Darunavir-Containing Highly Active Antiretroviral Therapy in Highly Pretreated Patients

The POWER Experience

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Abstract

Background: Very few studies have evaluated the cost of highly active antiretroviral therapy (HAART) per successful treatment in HIV-infected patients.

Objectives: To evaluate the cost of achieving undetectable plasma HIV-RNA levels in highly treatment-experienced, HIV-1-infected adults receiving darunavir/ritonavir (DRV/r 600 mg/100mg twice a day) or control protease inhibitor (PI)-based HAART.

Methods: The mean annual per-patient cost of DRV/r and control PI-based HAART was determined from the proportional use of antiretroviral agents in the DRV/r and control PI arms of the pooled POWER 1 and 2 trials, applying drug acquisition costs for 13 healthcare settings. The mean annual cost per patient of achieving undetectable plasma HIV-RNA levels (<50 copies/mL) was calculated by dividing the cost of each treatment by the proportion of patients with undetectable plasma HIV-RNA levels after 48 weeks in the DRV/r (45%) and control PI (10%) arms of the POWER trials.

Results: Whereas absolute costs of treatment were 1–19% higher with DRV/r versus control PI-based HAART depending on the healthcare setting, the mean annual per-patient cost of achieving undetectable plasma HIV-RNA levels was 73–78%lower. These cost savings were maintained in the sensitivity analyses, adjusting for control PI and enfuvirtide use, and the number of active drugs in the background regimen. The incremental annual cost per additional patient achieving undetectable plasma HIV-RNA levels with DRV/r versus control PI-based HAART in POWER 1 and 2 (d4148) compared favourably with that determined for enfuvirtide (d137 740; TORO trials) and tipranavir/ritonavir (d32 176; RESIST) versus control therapy.

Conclusions: DRV/r-based HAART provided consistent reductions in the cost of achieving undetectable plasma HIV-RNA levels compared with control PI-based therapy in highly treatment-experienced patients across various healthcare settings. The incremental cost per additional patient achieving undetectable plasma HIV-RNA levels with DRV/r versus control PI-based HAART was also lower than that calculated for other treatment options in this population. These results suggest that DRV/r is an economically viable option for highly treatment-experienced patients.

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Acknowledgements

The authors would like to thank Tony Vangeneugden, Ben Van Baelen, Eric Lefebvre, Sabrina Spinosa-Guzman, Piet De Doncker and other members of the darunavir study team for their contributions. The authors also acknowledge Patrick Hoggard (medical writer, Gardiner-Caldwell Communications, Macclesfield, UK) for his editorial support. Finally, they wish to thank the investigators and the patients and their families for their participation and support during the POWER studies. This project was financially supported by Johnson & Johnson Pharmaceutical Services.

AMH has received consultancy payments from Tibotec to work on the health economics of darunavir. BC has served as a consultant on advisory boards, participated in speakers’ bureaux or conducted clinical trials with Roche, Boehringer-Ingelheim, Abbott, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Tibotec, Janssen, Merck, Pfizer, Siemens, Monogram Biosciences and Panacos. MJ has received consultancy fees and honoraria from GlaxoSmithKline, Boehringer-Ingelheim, Gilead Sciences, Roche Pharmaceuticals, Merck Sharp and Dohme, Bristol-Myers Squibb and Abbott Laboratories. MS has received honoraria for attending advisory boards and has received honoraria as a speaker on scientific boards. 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. Department of Pharmacology University of Liverpool, Liverpool,UK and Tibotec BVBA, Mechelen, Belgium

    Andrew M. Hill

  2. Hospital Universitari Germans Trias i Pujol and iris Caixa Foundation, Barcelona, Spain

    Bonaventura Clotet

  3. Royal Free Hospital, London, UK

    Margaret Johnson

  4. Department of Clinical Immunology, Medical Hospital of Hannover, Hannover, Germany

    Matthias Stoll

  5. Southwest Infectious Disease Associates, Dallas, Texas, USA

    Nicholas Bellos

  6. Johnson & Johnson Pharmaceutical Services LLC, Generaal De Wittelaan L11 B3, 2800, Mechelen, Belgium

    Erik Smets

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  1. Andrew M. Hill
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  2. Bonaventura Clotet
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Correspondence to Erik Smets.

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Hill, A.M., Clotet, B., Johnson, M. et al. Costs to Achieve Undetectable HIV RNA with Darunavir-Containing Highly Active Antiretroviral Therapy in Highly Pretreated Patients. Pharmacoeconomics 28 (Suppl 1), 69–81 (2010). https://doi.org/10.2165/11587460-000000000-00000

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