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首页> 外文期刊>AIDS Research and Human Retroviruses >Cost-effectiveness analysis of raltegravir in treatment-experienced HIV type 1-infected patients in Spain.
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Cost-effectiveness analysis of raltegravir in treatment-experienced HIV type 1-infected patients in Spain.

机译：西班牙接受过治疗的1型HIV感染患者中拉格列韦的成本效果分析。

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Raltegravir, a novel HIV-1 integrase inhibitor, has superior efficacy with optimized background treatment (OBT) vs. placebo + OBT in treatment-experienced HIV-1 patients. This study assessed the long-term cost effectiveness of raltegravir from a Spanish National Healthcare System perspective. A cohort-state-transition model was used to estimate clinical and economic outcomes associated with raltegravir + OBT vs. OBT alone. Subjects were stratified into health states according to HIV RNA level, CD4 count, and opportunistic infection (OI) history, and could transition into different health states over time based on projected long-term efficacy. Each health state was associated with a distinct treatment cost and utility (QoL) score. Model inputs for mortality, resource utilization, unit costs, OI risk, and long-term durability of viral suppression were obtained from clinical trials, published studies, and database analyses. Model outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2007 Euros per quality-adjusted life-year (euro/QALY) gained. Costs and QALYs were discounted at 6% per year based on Spanish cost-effectiveness guidelines. Extensive sensitivity analyses were conducted. Five years of treatment with raltegravir + OBT resulted in an additional 4.5 years of undiscounted life expectancy vs. OBT alone. The ICER of raltegravir + OBT vs. OBT alone was euro22,908/QALY and euro31,431/QALY for 3- and 5-year use, respectively. Lower ICERs were observed with lower discount rates (3%) for costs and benefits, lower raltegravir price (20%), and shorter treatment duration (3 years). ICER was also sensitive to analytical time horizon and alternative sources of QoL scores. In treatment-experienced Spanish patients, raltegravir was projected to provide survival benefits and be cost effective.
机译：Raltegravir是一种新型的HIV-1整合酶抑制剂，在经历过治疗的HIV-1患者中，与优化的背景治疗（OBT）相比，安慰剂+ OBT具有更好的疗效。这项研究从西班牙国家医疗保健系统的角度评估了raltegravir的长期成本效益。使用队列状态转换模型来评估与raltegravir + OBT与单独OBT相关的临床和经济结果。根据HIV RNA水平，CD4计数和机会感染（OI）历史将受试者分为健康状态，并且根据预计的长期疗效，可能随时间推移而转变为不同的健康状态。每个健康状态都与不同的治疗费用和效用（QoL）得分相关。死亡率，资源利用，单位成本，OI风险和病毒抑制的长期持久性的模型输入来自临床试验，已发表的研究和数据库分析。报告的模型结果以每质量调整生命年（欧元/ QALY）获得的2007年欧元的成本效益比（ICER）增量表示。根据西班牙成本效益指南，成本和QALY每年折现6％。进行了广泛的敏感性分析。与仅使用OBT相比，使用raltegravir + OBT进行的五年治疗可额外延长4.5年的未折旧预期寿命。对于3年期和5年期使用，raltegravir + OBT与单独OBT的ICER分别为euro22,908 / QALY和euro31,431 / QALY。观察到较低的ICER，具有较低的成本和收益折扣率（3％），较低的raltegravir价格（20％）和较短的治疗时间（3年）。 ICER对分析时间范围和QoL分数的替代来源也很敏感。在有治疗经验的西班牙患者中，raltegravir预计将提供生存益处并具有成本效益。

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