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首页> 外文期刊>Clinical drug investigation >Cost Effectiveness of Lopinavir/ Ritonavir Tablets Compared with Atazanavir plus Ritonavir in Antiretroviral-Experienced Patients in the UK, France, Italy and Spain
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Cost Effectiveness of Lopinavir/ Ritonavir Tablets Compared with Atazanavir plus Ritonavir in Antiretroviral-Experienced Patients in the UK, France, Italy and Spain

机译：在英国，法国，意大利和西班牙接受抗逆转录病毒治疗的患者中，洛匹那韦/利托那韦片与阿扎那韦+利托那韦相比的成本效益

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Background and objective: Selection of antiretroviral therapy (ART) for antire-troviral-experienced patients should involve balancing multiple factors, including clinical efficacy, adverse-event risk, resistance concerns, cost effectiveness and expected budget impact. The efficacy of a regimen and its durability, as demonstrated in controlled clinical trials, must be considered in the light of short- and long-term economic impacts on the healthcare system. These impacts may vary based on drug costs, costs of reported adverse effects, the regimen's likelihood of contributing to viral resistance to second-line therapies and the marginal cost differences between other healthcare resources used over a patient's lifetime. Risk of coronary heart disease (CHD) may be of concern in the selection of ART, because differences in CHD risk factors have been reported for different regimens, and heart disease is both a deadly and costly condition. This study set out to estimate the long-term combined effects of HTV disease and antiretro viral-related risk for CHD on quality-adjusted survival and healthcare costs for antiretroviral-experienced patients in the UK, Spain, Italy and France. Methods: A previously validated Markov model was updated with 2006 cost estimates for each of the four countries and supplemented with the Framingham CHD risk equation. In the model, the average patient was male, aged 37 years, with a baseline 10-year CHD risk of 4.6%. Patients started with either lopinavir/ ritonavir (LPV/r) or ritonavir-boosted atazanavir (ATV+RTV) as the protease inhibitor (PI). Clinical trial results, local drug costs and AIDS and CHD cost estimates were used to estimate the differences between these two therapies. Results: There was a significant advantage using LPV/r over ATV+RTV, which varied depending on the country's cost structure and assumptions related to drug efficacy. There was a comparative benefit for experienced patients in quality-adjusted life-months (QALM) of 4.6 (the net gain after subtracting quality-adjusted life-years [QALYs] lost owing to CHD risk). In addition, there were 5-and 10-year overall cost savings of between E947 and E6594 per patient after 5 years, and an impact ranging from a cost increase of E308 (for France) to a cost saving of E7388 (for Spain) at year 10. The lifetime incremental cost-effectiveness ratios ranged from dominant for Spain to E11 856/QALY for Italy. Conclusion: LPV/r was a highly cost-effective regimen relative to ATV+RTV for the treatment of HTV for each of the four countries examined in this study. The effect of LPV/r on long-term CHD risk was minimal compared with the increased risk of AIDS/death projected for a less efficacious Pi-based regimen. The cost of lipid-lowering drugs and treatment for CHD was insignificant compared with the overall cost savings from LPV/r therapy. The choice of regimen for antiretroviral-experienced patients should be based on a regimen's expected efficacy and durability for countries with similar cost structure to those examined here.
机译：背景和目的：为有抗逆转录病毒治疗经验的患者选择抗逆转录病毒治疗（ART）应涉及多个因素之间的平衡，包括临床疗效，不良事件风险，耐药性，成本效益和预期的预算影响。如对照临床试验所示，方案的有效性及其持久性必须考虑到对医疗保健系统的短期和长期经济影响。这些影响可能会因药物成本，所报告的不良反应成本，方案对二线疗法产生病毒耐药性的可能性以及患者一生中使用的其他医疗资源之间的边际成本差异而异。冠心病（CHD）的风险可能是选择ART时应关注的问题，因为已报道了不同治疗方案所致CHD危险因素的差异，而且心脏病既致命又昂贵。这项研究旨在评估HTV疾病和CHD抗逆转录病毒相关风险对英国，西班牙，意大利和法国有抗逆转录病毒经验的患者进行质量调整后的生存和医疗保健费用的长期综合影响。方法：对先前验证过的马尔可夫模型进行了更新，其中包含四个国家/地区的2006年成本估算，并补充了Framingham CHD风险方程式。在该模型中，平均患者为男性，年龄37岁，基线10年冠心病风险为4.6％。患者开始使用洛匹那韦/利托那韦（LPV / r）或利托那韦增强的阿扎那韦（ATV + RTV）作为蛋白酶抑制剂（PI）。临床试验结果，当地药物费用以及AIDS和CHD费用估算用于估算这两种疗法之间的差异。结果：使用LPV / r优于ATV + RTV，这取决于国家的成本结构和与药物功效有关的假设而有所不同。有经验的患者在质量调整生命周期（QALM）中有4.6的相对收益（减去因CHD风险而损失的质量调整生命年[QALYs]后的净收益）。此外，在5年后，每位患者可以节省5至10年的时间，每位患者节省E947至E6594，其影响范围从E308的费用增加（法国）到E7388的费用节省（西班牙），第10年。整个生命周期内的增量成本效益比范围从西班牙的主要优势到意大利的E11 856 / QALY。结论：相对于ATV + RTV，LPV / r在本研究中研究的四个国家中都是相对于ATV + RTV治疗HTV的高成本效益方案。与预计无效的基于Pi的治疗方案导致的艾滋病/死亡风险增加相比，LPV / r对长期冠心病风险的影响微乎其微。与LPV / r疗法节省的总成本相比，降脂药物和冠心病治疗的费用微不足道。对于有抗逆转录病毒治疗经验的患者，应对方案的选择应基于与本文所考察成本结构相似的国家的方案预期疗效和持久性。

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