NDLI: Cost-effectiveness of optimized background therapy plus maraviroc for previously treated patients with R5 HIV-1 infection from the perspective of the Spanish health care system.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Moreno, Santiago González, Juan Lekander, Ingrid Martí, Belén Oyagüez, Itziar Sánchez-de la Rosa, Rainel Casado, Miguel Angel
Spatial Coverage	Spain
Description	Country affiliation: Spain Author Affiliation: Moreno S ( Hospital Ramón y Cajal, Madrid, Spain.)
Abstract	OBJECTIVE: The aim of this work was to evaluate the cost-effectiveness, from the perspective of the Spanish health care system, of optimized background therapy (OBT) plus maraviroc 300 mg BID versus OBT plus placebo in previously treated patients with R5 HIV-1 infection. METHODS: A lifetime cohort model was developed, based on 24- and 48-week pooled results from the Maraviroc Versus Optimized Therapy in Viremic Antiretroviral Treatment-Experienced Patients (MOTIVATE) studies 1 and 2, to reflect the Spanish health care system's perspective. Treatment duration was based on clinical trial follow-up from MOTIVATE 1 and 2. Clinical data, cohort characteristics, success probability, CD4 increase rate, CD4 cell status link to disease states, and adverse-event probability were taken from the MOTIVATE trials and other published literature. Other input parameters were taken from published sources. Antiretroviral (ARV) costs were derived from local sources. Non-ARV drug costs were obtained from published literature and a cost database. All costs were calculated as year-2009 euros. The annual discount rate was set at 3.0%. The main outcomes were cost per life-year gained (LYG) and cost per quality-adjusted life-year (QALY) gained. Uncertainty was assessed with one-way and probabilistic sensitivity analyses. RESULTS: In the model analysis, adding maraviroc to OBT was associated with an increase of 0.952 LYG and 0.909 QALY. Total costs were 275,970 for maraviroc plus OBT and 254,655 for placebo plus OBT (difference: 21,315). The incremental cost per LYG was 22,398 and the incremental cost per QALY gained was 23,457. The model appeared to be robust for variations in key parameters. Results from the probabilistic sensitivity analyses indicated that the probability of the cost per QALY being below 30,000 was 99%. CONCLUSION: Despite the limitations of the model, our analysis suggested that OBT plus maraviroc 300 mg BID is a clinically valuable option, and cost-effective from the perspective of the Spanish health care system, for previously treated patients with R5 HIV-1 infection.
File Format	HTM / HTML
ISSN	01492918
Issue Number	13
Volume Number	32
e-ISSN	1879114X
Journal	Clinical Therapeutics
Language	English
Publisher	Elsevier
Publisher Date	2010-12-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Anti-hiv Agents Economics Ccr5 Receptor Antagonists Cyclohexanes Hiv Infections Drug Therapy Hiv-1 Drug Effects Models, Economic Triazoles Adult Aged Administration & Dosage Therapeutic Use Cost-benefit Analysis Drug Therapy, Combination Female Hiv Fusion Inhibitors Immunology Virology Humans Male Markov Chains Middle Aged National Health Programs Quality-adjusted Life Years Spain Young Adult Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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Cost-effectiveness of optimized background therapy plus maraviroc for previously treated patients with R5 HIV-1 infection from the perspective of the Spanish health care system.

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