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CP-022 Cost-efficacy model of the introduction of emtricitabine/rilpivirine/tenofovir vs. the combination of tenofovir/emtricitabine + generic efavirenz in Spanish clinical practice
  1. J Lopez-Aldeguer1,
  2. A Antela2,
  3. J Mallolas3,
  4. MT Caloto4,
  5. I Montanyà4
  1. 1Hospital la Fe Valencia, Hospital la Fe Valencia, Valencia, Spain
  2. 2Hospital Clínico Universitario de Santiago de Compostela, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
  3. 3Hospital Clinic de Barcelona, Hospital Clinic de Barcelona, Barcelona, Spain
  4. 4Gilead Sciences, Gilead Sciences, Madrid, Spain

Abstract

Background The introduction to the Spanish market of generic efavirenz (gEFV) is expected by the end of 2013. This drug is part of the most prescribed treatment option in Spain for the treatment of HIV-1 infected adults (tenofovir/emtricitabine + efavirenz; TDF/FTC + EFV). Even though treatment with TDF/FTC + gEFV seems to be cheaper than other combinations only taking into account costs per pack, this treatment option may not be that attractive if we consider efficacy data.

Purpose To assess the cost-efficacy ratio of the set-dose combination of emtricitabine/rilpivirine/tenofovir (FTC/RPV/TDF) compared with TDF/FTC + gEFV for the management of treatment-naïve HIV-1 + adults with fewer than 100,000 copies/ml in Spain.

Materials and methods A Markov model was developed in order to project costs and health outcomes. The time horizon employed was 70 years, and the model had annual cycles. The model includes efficacy data of STaR Study, assuming that the efficacy of TDF/FTC + gEFV is the same as TDF/FTC/EFV. The analysis was undertaken because the Spanish National Healthcare System (NHS) perspective only considers direct medical costs. The pharmacological cost of TDF/FTC + gEFV option was calculated assuming that the price of gEFV would be 60% of branded EFV. The efficacy outcomes employed were Quality-Adjusted life years (QALYs) and Life Years Gained (LYGs). Both costs and healthcare outcomes were discounted at a 3% ratio. A Monte Carlo sensitivity analysis with 1,000 simulations was employed to confirm the model’s robustness.

Results This study shows a clear cost-effective advantage of FTC/RPV/TDF treatment compared to TDF/FTC + gEFV. Treatment with FTC/RPV/TDF is cost-saving and is more effective both in QALYs and LYG when compared with TDF/FTC + gEFV, representing savings of 2,086 € per patient. The sensitivity analysis carried out confirmed the model’s robustness, modifying costs and baseline CD4+ levels.

Conclusions Treatment with FTC/RPV/TDF is a recommended option when compared with TDF/FTC + gEFV, representing an efficient use of Spanish NHS resources.

No conflict of interest.

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