Helen King, MD, Charles B. Hicks, MD reviewing Girouard MP et al. Clin Infect Dis 2016 Mar 15.
A budget-impact analysis predicts that dual therapy with lamivudine and dolutegravir will be a cost saver, if the combination achieves high rates of virologic suppression.
The availability of newer, more potent antiretroviral treatment (ART) regimens has prompted reevaluation of the need for standard three-drug ART combinations. Dolutegravir (DTG), a highly potent and well-tolerated integrase strand transfer inhibitor with a high barrier to resistance, is a promising candidate drug for dual therapy. Clinical trials are under way evaluating dual therapy with DTG and lamivudine (3TC) for both initial and maintenance ART. If highly efficacious, this combination could generate considerable cost savings.
Now, researchers have conducted cost-effectiveness and budget-impact analyses using a simulation cohort whose characteristics matched those of untreated HIV-infected patients in the U.S. Four ART strategies were evaluated:
The three-drug strategy (DTG/abacavir/3TC) was not cost-effective, with an incremental cost-effectiveness ratio (ICER) >$500,000 per quality-adjusted life-year (QALY), compared with the induction–maintenance strategy, which had an ICER of $22,500 compared with no ART. If 50% of patients initiating ART were started on induction–maintenance or two-drug therapy, 5-year cost savings in the U.S. would reach an estimated $550 million or $800 million, respectively. Additionally, if 25% of currently suppressed patients switched to DTG + 3TC, the projected 5-year savings would exceed $3 billion.
Citation(s):
Girouard MP et al. The cost-effectiveness and budget impact of 2-drug dolutegravir-lamivudine regimens for the treatment of HIV infection in the United States. Clin Infect Dis 2016 Mar 15; 62:784.
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