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

Table 3.

Sensitivity analysis results.

ART strategy (ordered by costs)^a	Undiscounted LE (years)	Discounted LE (years)	Discounted lifetime costs	ICER ($/life-years saved)
Alternative patient populations and healthcare costs
South Africa: in-utero/intrapartum infection; presenting age 6 months
No ART	2.50	2.23	8520
First-line LPV/r	27.45	16.31	20 620	860
First-line NVP	26.29	15.81	21 960	Dominated^b
South Africa: in-utero/intrapartum infection; presenting age 24 months^c
No ART	3.54	3.09	12 670
First-line LPV/r	28.71	17.10	27 220	710
First-line NVP	27.52	16.59	29 600	Dominated
South Africa: in-utero/intrapartum infection; presenting age 35 months^c
No ART	4.71	4.03	14 420
First-line LPV/r	29.46	17.60	23 240	650
First-line NVP	28.36	17.11	24 790	Dominated
Côte d’Ivoire: in-utero/intrapartum infection; presenting age 12 months^d
No ART	2.83	2.52	1820
First-line LPV/r	28.79	17.11	15 120	910
First-line NVP	27.62	16.58	15 480	Dominated
Additional sensitivity analyses (South Africa, in-utero/intrapartum infection; presenting age 12 months)
One line of ART available
No ART	2.83	2.52	10 290
First-line NVP^a	22.42	14.57	24 890	1210
First-line LPV/r	23.84	15.31	26 490	2190
Stop second-line ART at failure
No ART	2.83	2.52	10 290
First-line NVP^a	23.76	15.03	17 360	565
First-line LPV/r	25.18	15.74	17 760	570
PENPACT-1 ART efficacies
No ART	2.83	2.52	10 290
First-line LPV/r	29.28	16.96	22 240	Weakly dominated^e
First-line NVP	30.42	17.39	22 370	810
Second-line NNRTI efficacy (40%)
No ART	2.83	2.52	10 290
First-line LPV/r	26.51	16.26	23 010	930
First-line NVP	27.61	16.59	23 370	1110
2.1× late failure for first-line LPV/r (1.9%/month)^f
No ART	2.83	2.52	10 290
First-line LPV/r	26.60	16.38	22 070	850
First-line NVP	27.61	16.59	23 370	6310
4.5× cost of liquid LPV/r ($80–105 per month for children <3 years of age)
No ART	2.83	2.52	10 290
First-line NVP^a	28.77	16.59	23 480	Weakly dominated
First-line LPV/r	27.58	17.10	23 510	910
15.0× cost of liquid LPV/r ($260–330 per month for children <3 years of age)
No ART	2.83	2.52	10 290
First-line NVP^a	27.58	16.58	23 780	960
First-line LPV/r	28.79	17.09	28 170	8640
Liquid LPV/r used until age 5
No ART	2.83	2.52	10 290
First-line LPV/r	28.77	17.09	22 730	850
First-line NVP	27.59	16.60	23 440	Dominated

Costs are in 2012 USD. Discounting is at 3% per year (results using alternative discount rates are shown in the Appendix (http://links.lww.com/QAD/A686). ART, antiretroviral therapy; DRV/r, darunavir/ritonavir; ICER, incremental cost-effectiveness ratio; LE, life expectancy; LPV/r, lopinavir/ritonavir; NNRTI, nonnucleoside reverse transcriptase inhibitor; NVP, nevirapine.

^aStrategies are listed in order of increasing costs. As a result, the order of the three treatment strategies changes between scenarios. Scenarios in which first-line NVP is less expensive over a lifetime horizon than first-line LPV/r are highlighted with footnote (a).

^b‘Dominated’ in this table refers to strong dominance: a strategy is both more expensive and less effective than its next less expensive alternative.

^cIn these analyses, the model simulates a cohort of children presenting to care and initiating ART at ages 6, 12, 24, and 35 months. Morbidity and mortality occurring among children before these ages are not included in these analyses. As a result, children presenting to care at older ages have longer projected life expectancies both with and without ART. This occurs because the model incorporates age-stratified mortality risks from HIV and non-HIV causes. High mortality rates among young, untreated children mean that children who survive without treatment to present to care at older ages are generally less sick, reflecting the ‘survivor bias’ seen in most cohorts of HIV-infected children [16–18]. These analyses are intended to evaluate the impact of age at ART initiation on the comparison between the two first-line regimens, and not to compare the outcomes of early versus delayed ART initiation.

^dBase-case results using Côte d’Ivoire costs are shown here. Full results for all analyses using Côte d’Ivoire costs are in the Appendix (http://links.lww.com/QAD/A686).

^eWeakly dominated. Here, refers to extended dominance: the incremental cost-effectiveness ratio (ICER) of the nondominated strategy compared to the dominated strategy is less than the ICER of the dominated strategy compared to no ART, indicating that the dominated strategy is an inefficient use of healthcare resources.

^fIn this scenario, we model a higher risk of late virologic failure (after initial suppression) for lopinavir/ritonavir in first-line ART, but no increase in late failure for nevirapine in first-line ART or for either second-line regimen. Such a scenario might occur if liquid lopinavir/ritonavir (administered to children too young to swallow pills) is much more difficult to tolerate than all other modeled regimens.