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. 2015 Jun 15;29(10):1247–1259. doi: 10.1097/QAD.0000000000000672

Fig. 3.

Multivariate sensitivity analyses: impact of simultaneous variation in antiretroviral therapy efficacy and costs.

Fig. 3

In each panel, the efficacy (proportion of treated children with HIV-RNA <400 copies/ml at 24 weeks) of the first-line LPV/r regimen is shown on the horizontal axis, and the efficacy of the first-line NVP regimen is shown on the vertical axis. Panel a shows results at base-case ART costs. Panel b shows results when the cost of LPV/r is reduced by half (when used in first-line or second-line ART, at any age). Panel c shows results when the cost of NVP is reduced by half (again, when used in first-line or second-line ART, at any age). Costs and life-years are discounted at 3% per year. Green shading indicates scenarios in which the first-line LPV/r strategy is cost-saving (leading to greater life expectancy and lower lifetime costs), compared to the first-line NVP strategy. Yellow shading indicates scenarios in which first-line LPV/r is very cost-effective compared to first-line NVP (ICER of first-line LPV/r compared to first-line NVP is less than South Africa per-capita GDP ($7500)/YLS, or first-line NVP is more effective and more expensive, but its ICER compared to first-line LPV/r is greater than $7500/YLS). Orange shading indicates scenarios in which first-line LPV/r is no longer very cost-effective (first-line LPV/r is more effective and more expensive than first-line NVP, but its ICER relative to first-line NVP is >$7500/YLS, or first-line NVP is more effective and more expensive, and its ICER relative to first-line LPV/r is <$7500). Red shading indicates scenarios in which first-line LPV/r is strongly or weakly dominated by first-line NVP (weak dominance: first-line LPV/r is less effective and less expensive, but represents an inefficient use of resources; strong dominance: first-line LPV/r leads to lower life expectancy and greater lifetime costs). Following WHO GDP-based guidance, cost-effectiveness results support the choice of first-line LPV/r in the green- and yellow-shaded scenarios and the choice of first-line NVP in the orange- and red-shaded scenarios. ART, antiretroviral therapy; GDP: gross domestic product; ICER, incremental cost-effectiveness ratio; LPV/r, lopinavir/ritonavir; NVP, nevirapine; YLS, year of life saved.