Background and importance Recently, the GEMINIS I and II studies have demonstrated how lamivudine (3TC) with dolutegravir (DTG) bitherapy in naive patients is as effective as conventional triple therapy after 48 weeks of follow-up.1
Aim and objectives To analyse the 5 year economic impact of bitherapy treatment of HIV naive patients from the perspective of hospital management in a third level hospital
Material and methods A mathematical model in Excel format was designed to estimate the difference in costs between DTG/3TC bitherapy and the conventional regimens described in the GESIDA guide2 for naive patients, with a 5 year perspective:
Dolutegravir+emtricitabine/tenofovir alafenamide (DTG+FTC/TAF)
Raltegravir+emtricitabine/tenfovir alafenamide (RAL+FTC/TAF)
The model was applied using an incidence of the disease of 8.6 new cases per 100 000 inhabitants (epidemiological surveillance information system of the government of Spain). The budgetary impact on a reference hospital serving a reference population of 350 000 was estimated. The unit cost of the drugs was obtained from the BOTplus database.
Results The cost per month of treatment for the different recommended regimens was: 1007.43€ for DTG+FTC/TAF, 1122.73€ for RAL+FTC/TAF, 863.00€ for DTG/ABC/3TC and 637.74€ for 3TC+DTG bitherapy.
The introduction of bitherapy meant a saving compared with other alternatives:
485€ patient/year compared with RAL+FTC/TAF and 634 366.92€ (43.2%) after 5 years of treatment.
370€ patient/year compared with DTG+FTC/TAF and 483 946.92€ (36.7%) after 5 years of treatment.
225.26€ patient/year compared with DTG+ABC/3TC therapy and 294 640.08€ (26.1%) after 5 years of treatment.
Conclusion and relevance HIV treatment continues to have a high budgetary impact. The introduction of bitherapy (3TC/DTG) in naive patients would mean a reduction in the direct costs of treating this pathology, with a saving of up to 40% compared with conventional therapies.
References and/or acknowledgements 1. Cahn P, et al. Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials. Lancet 2019;393(10167):143–155.
2. Gesida-seimc. 2018. available at: http://gesida-seimc.org/wp-content/uploads/2019/02/Guia_Tar_Gesida_Ene_2019.pdf
No conflict of interest.
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