Cost Effectiveness of Combination HIV Therapy
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Pharmacoeconomics 2000 Apr; 17 (4): 325-330 1170-7690/00/0004-0325/$20.00/0 © Adis International Limited. All rights reserved.
Cost Effectiveness of Combination HIV Therapy 3 Years Later Richard D. Moore Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Abstract
Since 1997, expert panel guidelines for HIV care have recommended the use of combination antiretroviral therapy with at least 3 antiretroviral drugs. Several studies have examined the cost effectiveness of 3-drug combination antiretroviral regimens for the treatment of HIV infection. Analyses comparing a 3-drug protease inhibitor-containing regimen with a 1- or 2-drug non-nucleoside reverse transcriptase inhibitor regimen have consistently yielded incremental direct cost estimates ranging from $US10 000 to just over $US13 000 per year of life saved. In Western societies, such an incremental cost per year of life saved compares favourably with chronic therapy for other diseases and argues for the adoption of these drugs by payors and policy makers. The reason for this favourable costeffectiveness ratio appears to be the decrease in opportunistic complications and hospitalisation associated with the effective use of combination antiretroviral therapy. Whether this initial benefit will be maintained is not yet known. Other comorbid illnesses such as hepatitis C or renal failure may subsequently increase the cost of HIV care, and some analyses suggest that resistance may develop to these drugs over the long term. In addition, studies are needed to assess the cost effectiveness of these therapies in developing countries where the expense of these drugs appears to put them out of reach. The collection and analysis of economic data will continue to be needed as newer HIV therapies become available and the HIV healthcare environment evolves. Quantifying medical care costs and calculating cost effectiveness involve assessing a moving target. Economic analyses of HIV infection must evolve in tandem with therapeutic changes to continue to be relevant to policy makers, payors of care, and those who provide and receive HIV care.
In 1996, I wrote an editorial for this journal that presented a model for the cost effectiveness of the, at that time, new approach to HIV therapy with protease inhibitor-containing combination antiretroviral regimens.[1] Combination therapy with 3 antiretroviral drugs was not yet a guideline-based recommendation, and the effectiveness data were limited to early clinical trials with relatively short follow-up. Our analysis suggested that the incre-
mental cost effectiveness of a protease inhibitorcontaining 3-drug regimen would be $US10 000 (1996 values) per additional year of life saved compared with the previously standard HIV therapy with 1 nucleoside reverse transcriptase inhibitor. By 1997, expert panel guidelines from the US were recommending use of a protease inhibitor combined with 2 reverse transcriptase inhibitors as preferred therapy, and the use of a non-nucleoside
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Table I. Antiretroviral drugs
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