A monotherapy strategy using lopinavir/ritonavir, with prompt re-initiation of combination antiretroviral therapy (cART) in the event of viral load rebound, appears to be cost-effective when compared with cART using efavirenz/emtricitabine/tenofovir in HIV-1-infected patients with viral suppression in France.

Monotherapy was estimated to save − €3296 (95% confidence interval [CI] − 5202 to − 1391) per patient over 2 years when considering antiretroviral drug prices over the study period (2009–2013) and − €1456 (95% CI – 3300 to 388) when considering antiretroviral drug prices in 2018, whereas health benefits were not significantly different between the two strategies in terms of quality-adjusted life-years.

The current monthly price of cART would have to decrease by 34% (from €573.3 to − 378.4) to become the preferred strategy with a probability of 95%.

As the cost-effectiveness of monotherapy versus cART is highly dependent on antiretroviral drug prices, it is essential to provide information for policy making on the economic value of this strategy for a large range of price combinations of both treatments using cost-effectiveness price-threshold analysis.