Budget impact analysis of the simplification to atazanavir + ritonavir + lamivudine dual therapy of HIV-positive patients receiving atazanavir-based triple therapies in Italy starting from data of the Atlas-M trial

Figures & data

Figure 1 Structure of the budget impact model.

Abbreviations: ATV, atazanavir; NRTI, nucleoside reverse transcriptase inhibitor; EVG, elvitegravir; c, cobicistat; TDF, tenofovir; FTC, emtricitabine; r, ritonavir; 3TC, lamivudine.

Table 1 Number of patients switched to dual therapy per year in each scenario

Scenario	Year 1	Year 2	Year 3	Year 4	Year 5
Base case	0	0	0	0	0
Scenario 1	361	282	222	176	141
Scenario 2	602	394	262	179	124
Scenario 3	903	447	230	126	75

Notes: In the base case scenario none of the eligible patients is assigned to ATV+r+3TC; in scenario 1 one fifth of eligible patients are assigned to ATV+r+3TC; in scenario 2 one third of eligible patients are assigned to ATV+r+3TC; in scenario 3 one half of eligible patients are assigned to ATV+r+3TC.

Abbreviations: ATV, atazanavir; r, ritonavir; 3TC, lamivudine.

Table 2 Per capita annual costs considered in the model

ART	ART (€)	Hospitalization (€)	Outpatient activity (€)	Other drugs (€)	Per capita annual cost (€)
ATV+r+2 NRTI^	7,958.7	12.5	391.0	0.4	8,362.6
ATV+r+3TC	4,015.7	15.3	382.8	0.05	4,413.9
EVG/c/TDF/FTC	8,340.8	12.5*	391.0*	0.4*	8,744.7
TDF/FTC+ATV+r	8,332.5	12.5*	391.0*	0.4*	8,736.4

Notes:

^ NRTI costs consider a weighted mean of the cost of the backbones used within the Atlas-M trial,²⁰ that is, TDF/FTC; TDF+3TC; ABC+3TC; AZT+3TC; ddl+3TC; TDF+ABC.

* Because of lack of data, the same cost of ATV+r+2 NRTI was considered.

Abbreviations: ART, antiretroviral treatment; ATV, atazanavir; NRTI, nucleoside reverse transcriptase inhibitor; r, ritonavir; EVG, elvitegravir; c, cobicistat; TDF, tenofovir; FTC, emtricitabine; 3TC, lamivudine; ABC, abacavir; ddl, didanosine; AZT, zidovudine.

Table 3 Patient distribution among different ART

		Year 1	Year 2	Year 3	Year 4	Year 5
Base case	ATV+r+2 NRTI	95.5%	91.3%	87.4%	83.8%	80.4%
	ATV+r+3TC	0.0%	0.0%	0.0%	0.0%	0.0%
	EVG/c/TDF/FTC	2.2%	4.3%	6.3%	8.1%	9.8%
	TDF/FTC+ATV+r	2.2%	4.3%	6.3%	8.1%	9.8%
Scenario 1	ATV+r+2 NRTI	48.7%	24.6%	13.2%	7.8%	5.3%
	ATV+r+3TC	46.9%	68.5%	78.4%	82.8%	84.4%
	EVG/c/TDF/FTC	2.2%	3.6%	4.6%	5.4%	6.2%
	TDF/FTC+ATV+r	2.2%	3.3%	3.8%	4.0%	4.1%
Scenario 2	ATV+r+2 NRTI	64.3%	41.9%	28.2%	19.3%	13.7%
	ATV+r+3TC	31.3%	50.6%	62.5%	69.8%	74.2%
	EVG/c/TDF/FTC	2.2%	3.9%	4.8%	5.8%	6.7%
	TDF/FTC+ATV+r	2.2%	3.6%	4.5%	5.1%	5.4%
Scenario 3	ATV+r+2 NRTI	76.8%	59.4%	46.3%	36.5%	29.0%
	ATV+r+3TC	18.7%	32.7%	43.0%	50.7%	56.3%
	EVG/c/TDF/FTC	2.2%	4.0%	5.5%	6.8%	7.9%
	TDF/FTC+ATV+r	2.2%	3.9%	5.1%	6.1%	6.8%

Notes: In the base case scenario none of the eligible patients is assigned to ATV+r+3TC; in scenario 1 one fifth of eligible patients are assigned to ATV+r+3TC; in scenario 2 one third of eligible patients are assigned to ATV+r+3TC; in scenario 3 one half of eligible patients are assigned to ATV+r+3TC.

Abbreviations: ART, antiretroviral treatment; ATV, atazanavir; r, ritonavir; NRTI, nucleoside reverse transcriptase inhibitor; EVG, elvitegravir; c, cobicistat; TDF, tenofovir; FTC, emtricitabine; 3TC, lamivudine.

Table 4 Results of the budget impact analysis

	Annual cost (million €)
	Year 1	Year 2	Year 3	Year 4	Year 5	Total
Base case	16.1	16.5	16.8	17.0	17.3	83.7
Scenario 1	14.7	13.9	13.3	13.0	12.7	67.7
Δ between Scenario 1 and base case (% impact)	−1.4 (−8.8%)	−2.5 (−15.4%)	−3.4 (−20.3%)	−4.1 (−23.9%)	−4.6 (−26.6%)	−16.0 (−19.2%)
Scenario 2	13.8	12.5	11.8	11.4	11.3	60.8
Δ between Scenario 2 and	−2.4	−3.9	−4.9	−5.6	−6.1	−22.9
base case (% impact)	(−14.7%)	(−23.8%)	(−29.5%)	(−33.0%)	(−35.1%)	(−27.4%)
Scenario 3	12.6	11.1	10.6	10.4	10.4	55.1
Δ between Scenario 3 and base case (% impact)	−3.6 (−22.1%)	−5.3 (−32.3%)	−6.2 (−37.0%)	−6.7 (−39.1%)	−6.9 (−39.9%)	−28.7 (−34.2%)

Notes: In the base case scenario none of the eligible patients is assigned to ATV+r+3TC; in scenario 1 one fifth of eligible patients are assigned to ATV+r+3TC; in scenario 2 one third of eligible patients are assigned to ATV+r+3TC; in scenario 3 one half of eligible patients are assigned to ATV+r+3TC.

Di GiambenedettoSFabbianiMQuiros RoldanETreatment simplification to atazanavir/ritonavir plus lamivudine versus maintenance of atazanavir/ritonavir plus two nucleoside reverse transcriptase inhibitors in virologically-suppressed HIV-1-infected patients: 48-weeks results from a randomized trial (ATLAS-M)J Antimicrob ChemotherIn press2017

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