A Microsimulation of the Cost-effectiveness of Maraviroc for Antiretroviral Treatment-Experienced HIV-Infected Individuals

Abstract

Purpose: Maraviroc (MVC) is the first approved CCR5 antagonist. The aim of this study was to explore the cost-effectiveness of MVC in treatment-experienced or treatment-resistant HIV-infected adults.Methods: The validated HIV microsimulation model ARAMIS was used to predict clinical and economic outcomes of treating patients with optimized background therapy (OBT) alone, as compared to a strategy of testing for the patient’s viral tropism and treating with OBT with or without (±) MVC in a cohort corresponding to the MOTIVATE screening cohort.Results: Compared to treatment with OBT alone, a treatment strategy of OBT ± MVC (twice daily) according to tropism test result was predicted to increase CD4+ cell count after 5 years (from mean 249 to 360 cells/μL), undiscounted life expectancy (7.6 to 8.9 years), and quality-adjusted life years (QALYs; from 4.99 to 5.71) for an additional $40,500, giving an incremental cost-effectiveness ratio of $56,400 per QALY gained. The result was relatively insensitive to alternative clinical and cost assumptions within reasonable ranges, but for individuals with HIV susceptible to only two or fewer components of OBT, the ICER decreased to $52,000 per QALY gained.Conclusion: MVC is cost-effective, especially among individuals with few remaining options for active antiretroviral therapy.

Keywords:

• AIDS
• anti-HIV agents
• cost-effectiveness
• economic model
• HIV
• Monte Carlo method