BACKGROUND: Tenofovir/emtricitabine (TDF/FTC) and abacavir/lamivudine (ABC/3TC) are preferred backbones for treatment-naive adults with HIV-1 infection. Health-economic analysis is needed to determine the cost-effective option.
OBJECTIVES: To assess the cost-effectiveness of the four comparators examined in the AIDS Clinical Trials Group (ACTG) 5202 clinical trial, TDF/FTC or ABC/3TC in combination with efavirenz (EFV) or atazanavir/ritonavir (ATV/r), in France and Spain.
METHODS: A Markov model with six health states based on CD4+ cell-count ranges was developed to estimate costs and health outcomes for individuals on first-line therapy. Head-to-head efficacy data (lack of regimen failure, mean CD4+ cell-count changes) up to 192 weeks for TDF/FTC+EFV, TDF/FTC+ATV/r, ABC/3TC+EFV, and ABC/3TC+ATV/r were obtained from the ACTG 5202 clinical trial. Country-specific antiretroviral drug costs and other direct medical costs (2014 Euros), mortality, and utility values were obtained from published sources. All outcomes were discounted at 3.0% per year. Sensitivity and subgroup analyses were conducted, including analysis of low (<100,000 copies/mL) and high (≥100,000 copies/mL) baseline viral load.
RESULTS: In both countries examined, individuals using TDF/FTC-based regimens were predicted to remain on first-line therapy longer and accrue more QALYs than individuals using ABC/3TC-based regimens. TDF/FTC-based regimens were cost-effective compared with ABC/3TC-based regimens, with incremental cost-effectiveness ratios (ICERs) below a willingness-to-pay threshold of €30,000 per QALY gained. ICERs were €14,787 and €15,220 for TDF/FTC+EFV versus ABC/3TC+EFV and were €18,202 and €18,953 for TDF/FTC+ATV/r versus ABC/3TC+ATV/r for France and Spain, respectively. In subgroup analyses, TDF/FTC-based regimens were predicted to yield more QALYs and to remain cost-effective compared with ABC/3TC-based regimens.
CONCLUSIONS: In an analysis of the regimens examined in ACTG 5202 for treatment-naive adults with HIV-1 infection, regimens containing TDF/FTC yielded more favorable health outcomes and were predicted to be cost-effective compared with regimens containing ABC/3TC.
