Skip to main content
SpringerLink
Log in

Cost-effectiveness analysis of lopinavir/ritonavir and atazanavir+ritonavir regimens in the CASTLE study

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

The purpose of the study was to conduct a cost-effectiveness analysis and budget impact analysis comparing lopinavir with ritonavir (LPV/r) and atazanavir plus ritonavir (ATV+RTV) for antiretroviral-naïve patients with a baseline CD4+ T-cell distribution and total cholesterol (TC) profile as reported in the CASTLE study.

Methods

This decision analysis study used a previously published Markov model of HIV disease, incorporating coronary heart disease (CHD) events to compare the short- and long-term budget impacts and CHD consequences expected for the two regimens.

Results

Patients were assumed to have a baseline CHD risk of 4.6% (based on demographic data) and it was also assumed that 50% of the population in the CASTLE study were smokers. The CHD risk differences (based on percent of patients with TC >240 mg/dL) in favor of ATV+RTV resulted in an average improvement in life expectancy of 0.031 quality-adjusted life years (QALYs) (11 days), and an incremental cost-effectiveness ratio of $1,409,734/QALY. Use of the LPV/r regimen saved $24,518 and $36,651 at 5 and 10 years, respectively, with lifetime cost savings estimated at $38,490. A sensitivity analysis using a cohort of all smokers on antihypertensive medication estimated an average improvement in life expectancy of 31 quality-adjusted days in favor of ATV+RTV, and a cost-effectiveness ratio of $520,861/QALY: a ratio that is still above the acceptable limit within the US.

Conclusion

The use of an LPV/r-based regimen in antiretroviral-naïve patients with a baseline CHD risk similar to patients in the CASTLE study appears to be a more cost-effective use of resources compared with an ATV+RTV-based regimen. The very small added CHD risk predicted by LPV/r treatment is more than offset by the substantial short- and long-term cost savings expected with the use of LPV/r in antiretroviral-naïve individuals with average to moderately elevated CHD risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chen RY, Accortt NA, Westfall AO, et al. Distribution of health care expenditures for HIV-infected patients. Clin Infect Dis. 2006;42:1003–1010.

    Article  PubMed  CAS  Google Scholar 

  2. Simpson KN, Luo M, Chumney ECG, King MS, Brun S. Cost-effectiveness of lopinavir/ritonavir compared to atazanavir in antiretroviral-naïve patients: modeling the combined effects of HIV and heart disease. Clin Drug Invest. 2007;27:67–74.

    Article  CAS  Google Scholar 

  3. D’Agostino RB, Russell MW, Huse DM, et al. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J. 2000;139:273–281.

    Google Scholar 

  4. Friis-Moller N, Reiss P, El-Sadr W, et al. Exposure to PIs and NNRTI and risk of myocardial infarction: results of the D:A:D study. Presented at: 13th Conference on Retroviruses and Opportunistic Infections; February 5–8, 2006; Denver, Colorado. Session 35. Oral abstract 144.

  5. Molina JM, Andrade-Villanueva J, Echevarria J, et al. Once-daily atazanavir/ritonavir versus twice-daily lopinavir/ritonavir, each in combination with tenofovir and emtricitabine, for management of antiretroviral-naïve HIV-1-infected patients: 48 week efficacy and safety results of the CASTLE study. Lancet. 2008;372:646–655.

    Article  PubMed  CAS  Google Scholar 

  6. Ghani AC, de Wolf F, Ferguson NM, et al. Surrogate markers for disease progression in treated HIV infection. J Acquir Immune Defic Syndr. 2001;28:226–231.

    PubMed  CAS  Google Scholar 

  7. Ghani AC, Henley WE, Donnelly CA, Mayer S, Andersen RM. Comparison of the effectiveness of non-nucleoside reverse transcriptase inhibitor-containing and protease inhibitor-containing regimens using observational databases. AIDS. 2001;15:1133–1142.

    Article  PubMed  CAS  Google Scholar 

  8. Mocroft A, Ruiz L, Reiss P, et al. Virological rebound after suppression on highly active antiretroviral therapy. AIDS. 2003;17:1741–1751.

    Article  PubMed  Google Scholar 

  9. Castiel D, Herve C, Gaillard M, et al. Cost-utility analysis of early thrombolytic therapy. Pharmacoeconomics. 1992;1:438–442.

    Article  PubMed  CAS  Google Scholar 

  10. Fleming T, ed. Red Book 2007: Pharmacy’s Fundamental Reference. Montvale NJ: Thompson Healthcare; 2007.

    Google Scholar 

  11. Simpson KN, Luo MP, Chumney EG, Sun E, Brun S, Ashraf T. Cost effectiveness of using lopinavir/ritonavir vs. nelfinavir as the first highly active antiretroviral regimen for HIV infection. HIV Clin Trials. 2004;5:294–304.

    Article  PubMed  Google Scholar 

  12. Simpson KN, Roberts G, Hicks CB, et al. Cost-effectiveness of tipranavir in treatment-experienced HIV patients in the United States. HIV Clin Trials. 2008;9:224–236.

    Article  Google Scholar 

  13. Dolan P. Modeling valuations for EuroQoL health states. Med Care. 1998;35:1095–1108.

    Article  Google Scholar 

  14. Mrus JM, Yi MS, Freedberg KA, et al. Utilities derived from visual analog scale scores in patients with HIV/AIDS. Med Decis Making. 2003;23: 414–421.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical University of South Carolina, 151 B Rutledge Avenue, Room 409, Charleston, South Carolina, 29425, USA

    Kit N. Simpson

  2. Abbott Laboratories, Abbott Park, Illinois, USA

    Rukmini Rajagopalan

  3. Abbott GmbH & Co KG, Ludwigshafen, Germany

    Birgitta Dietz

Authors
  1. Kit N. Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rukmini Rajagopalan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Birgitta Dietz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kit N. Simpson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simpson, K.N., Rajagopalan, R. & Dietz, B. Cost-effectiveness analysis of lopinavir/ritonavir and atazanavir+ritonavir regimens in the CASTLE study. Adv Therapy 26, 185–193 (2009). https://doi.org/10.1007/s12325-008-0141-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-008-0141-8

Keywords

Search

Navigation