Cost-minimization comparison of darunavir plus ritonavir and lopinavir/ritonavir in HIV-1 infected treatment-naïve women of childbearing age

Figures & data

Table 1. Demographic and baseline characteristics of WOCBA and selected key cost inputs.

Input	Value		Source
Age distribution of HIV+ women	On ARV-regimen	Birth rate	Distribution of antiretroviral-naїve women aged 18–45 years at baseline in ACTG trials 5102 and 5142 and M05-730 (n = 434), Arizona State Healthcare Cost and Utilization Project data using ICD-9 codes 042.xx or V08 in 2008 and 200912.
<20 years	1%	40.1%
20–24 years	9%	21.2%
25–29 years	17%	10.4%
30–34 years	24%	10.0%
35–39 years	23%	5.2%
40–44 years	26%	0.9%
Baseline viral load			Distribution of antiretroviral-naїve women aged 18–45 years at baseline in ACTG trials 5102 and 5142 and M05-730 (n = 434)12.
<50	0%
50–400	0%
400–9999	19%
10,000–24,999	16%
25,000–49,999	17%
50,000–74,999	9%
75,000–99,999	6%
>100,000	33%
Baseline CD4+ count			Distribution of antiretroviral-naїve women aged 18–45 years at baseline in ACTG trials 5102 and 5142 and M05-730 (n = 434)12.
<50	18%
50–99	10%
100–199	19%
200–349	36%
350–499	13%
500–700	4%
Virologic suppression (% with <50 copies/mL at 48 weeks)			Ortiz et al.9
LPV/r + TRV	78%
DRV + RTV + TRV	84%
Daily wholesale acquisition cost:			AnalySource Online. [cited May 20, 2011]; Available from: http://www.firstdatabank.com/Products/analysource.aspx
LPV/r (400 mg/100 mg BID) + TRV  (FTC 200 mg + TDF 300 mg daily)	$56.59 per day
DRV + RTV (800 mg + 100 mg daily) + TRV  (FTC 200 mg + TDF 300 mg daily)	$73.89 per day
Liver function test	$47 per test		Medical Fees in the United States. Professional Medical Careers Institute, Los Angeles. US median charges for 2008 inflated to 2010 using the Medical Care CPI table from www.bls.gov
ARV regimen switch costs (physician visit, blood count, CD4+ test, VL test, genotypic resistance)	$1409 per switch
Cost of management MI	$26,602 per episode		Jaime Caro et al.32
Cost of management stroke	$21,852 per episode
Cost of management AIDS acute events (depends on event type)	$1336–$25,209 per episode		Event Data for South Carolina Medicaid patients from 2002 and 200312
Cost of management AIDS chronic events (depends on event type)	$421–$10,000 per month

Table 2. Health-related outcomes and discounted costs breakdown associated with the base case.

Result	5 years		10 years
	LPV/r + TRV	DRV + RTV + TRV	LPV/r + TRV	DRV + RTV + TRV
Health-related outcomes
QALYs	3.32	3.33	5.95	5.98
Life-years	4.25	4.26	7.68	7.69
Death (%)	11.37	11.20	20.12	19.67
AIDS-related event(s) (%)	13.13	12.56	19.48	18.10
CHD (%)	0.87	1.03	1.27	1.78
Discounted costs
Inpatient costs	$4879	$4687	$8682	$7920
Treating AIDS-related event	$2529	$2285	$4337	$3701
Treating for non-AIDS related cancer	$1439	$1476	$2996	$2819
Treating for non-AIDS related infection	$193	$183	$286	$276
Treating serious SEs	$567	$566	$871	$866
Treating CHD	$151	$177	$191	$257
Outpatient costs	$102,911	$128,007	$183,671	$227,935
ARV drugs	$82,726	$106,795	$150,522	$193,432
Other concomitant drugs	$1822	$1680	$2474	$2236
Medical doctor visits	$15,763	$16,818	$25,286	$26,986
Treating AIDS-related event	$1389	$1401	$2436	$2161
Treating for non-AIDS related cancer	$142	$146	$296	$279
Treating for non-AIDS related infection	$158	$150	$234	$226
Treating non-serious SEs	$55	$115	$85	$181
Treating CHD	$153	$180	$198	$264
Treating lipoatrophy	$704	$723	$2141	$2169
Treating lipodystrophy	$0	$0	$0	$0
Total healthcare costs	$107,790	$132,694	$192,352	$235,854

Figure 1. Scatterplot showing incremental costs and QALYs at 10 years for alternative scenarios. Currencies are in US dollars.

Table 3. Total healthcare costs for base-case and alternative scenarios.

Scenario	Total healthcare costs
	5 years		10 years
	LPV/r + TRV	DRV + RTV + TRV	LPV/r + TRV	DRV + RTV + TRV
Base Case: 100% start LPV vs 100% start DRV & 0%switch	$107,790	$132,694	$192,352	$235,854
100% start LPV vs 100% start DRV & 30%switch	$108,255	$132,196	$192,684	$234,250
100% start LPV vs 100% start DRV & 100%switch	$108,439	$129,783	$192,862	$226,065
100% start LPV vs 100% start DRV & 0%switch PregRate + 25%	$108,248	$133,329	$192,665	$237,549
100% start LPV vs 100% start DRV & 0%switch PregRate − 25%	$107,595	$132,897	$192,087	$236,202
100% start LPV vs 100% start DRV & 0%switch AdherenceNoChange	$107,375	$132,085	$190,826	$234,500
100% start LPV vs 100% start DRV & 0%switch Adherence + 50%	$108,010	$132,932	$192,860	$236,308
100% start LPV vs 100% start DRV & 100%switch PregRate + 25%	$108,103	$128,979	$191,951	$224,567
100% start LPV vs 100% start DRV & 100%switch PregRate − 25%	$107,875	$129,807	$192,069	$228,225
100% start LPV vs 100% start DRV & 100%switch AdherenceNoChange	$107,978	$129,634	$192,096	$225,646
100% start LPV vs 100% start DRV & 100%switch Adherence + 50%	$108,548	$129,778	$193,105	$225,976
All patients start-CD4 count above 200 cells/mm^3	$107,032	$132,860	$195,067	$241,130
All patients start-CD4 count above 350 cells/mm^3	$106,909	$132,916	$196,258	$242,403
All patients start-CD4 count above 500 cells/mm^3	$106,645	$132,709	$195,669	$242,686
All patients start-CD4 count in the range of 350–499 cells/mm^3	$106,996	$132,964	$195,133	$242,585
All patients start-CD4 count in the range of 200–249 cells/mm^3	$106,966	$132,881	$194,486	$240,565
All patients start-CD4 count below 200 cells/mm^3	$110,126	$133,845	$191,097	$233,480
Both arms use RAL + CBV as 2nd line after side effect	$107,090	$132,656	$190,140	$235,008
Start on LPV(DRV) get 2nd line DRV(LPV), RAL + CBV for 3rd	$108,172	$132,258	$193,033	$234,734
All patients were highly adherent to ARV treatment at baseline	$112,551	$138,863	$199,847	$247,098
All patients were moderately adherent to ARV treatment at baseline.	$108,682	$133,349	$193,418	$238,440
All patients were poorly adherent to ARV treatment at baseline.	$66,279	$79,067	$117,063	$140,165
All patients had start-CD4 >350 and ViralLoad <100 K	$106,884	$133,108	$195,514	$243,281
All patients had start-CD4 <100 and ViralLoad >100 K	$109,921	$133,537	$189,080	$230,236
All patients had start-CD4 <200 and ViralLoad >100 K	$109,330	$133,348	$188,479	$231,922
Both arms have the same rates of non-serious side-effects	$108,321	$133,058	$192,726	$237,292
Both arms have the same rates of treatment discontinuation due to non-virologic reasons	$111,621	$131,680	$200,997	$231,740
Utilities as commonly used in the HIV literature	$107,790	$132,694	$192,352	$235,854
Baseline utility values were set to 1	$107,790	$132,694	$192,352	$235,854
Event utility decrement were all set to 0	$107,790	$132,694	$192,352	$235,854
Decision on primary virologic failure after 12 weeks (BC 24)	$109,170	$135,285	$194,173	$241,304

Figure 2. Scatterplot of probabilistic sensitivity analysis showing incremental costs and QALYs at 10 years for three scenarios with varying assumptions on probability of switching from DRV + RTV to LPV. Incremental costs are in US dollars. SD, standard deviation.

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