Table 4.
Quality-adjusted life-years (QALYs), costs (US dollars, 2016) and cost-effectiveness estimated over 24 months of follow-up (ANRS 12169 2LADY, n = 451)
| TDF/FTC LPV/r (arm A, n = 152) Mean (95% CI) |
ABC ddI LPV/r (arm B, n = 145) Mean (95% CI) |
TDF/FTC DRV/r (arm C, n = 154) Mean (95% CI) |
Difference or ICER ABC ddI LPV/r vs TDF/FTC LPV/r Mean (95% CI) |
Difference or ICER TDF/FTC DRV/r vs TDF/FTC LPV/r Mean (95% CI) |
|
|---|---|---|---|---|---|
| Base-case analysis | |||||
| ARV drugs prices observed during 2016a | |||||
| Total costs per patient (USD) | |||||
| Burkina Fasof | 1085 (1056–1104) | 1496 (1367–1584) | 1573 (1529–1604) | 410 (280–505) | 488 (439–532) |
| Cameroong | 1352 (1308–1396) | 1884 (1804–1961) | 1820 (1760–1873) | 532 (441–621) | 468 (395–538) |
| Senegalh | 1461 (1396–1511) | 2183 (2103–2258) | 2008 (1751–2216) | 721 (626–819) | 546 (283–764) |
| QALYs per patientb | |||||
| Burkina Fasof | 1.098 (1.003–1.192) | 1.119 (0.989–1.232) | 1.126 (1.030–1.218) | 0.021 (− 0.140 to 0.169) | 0.028 (− 0.107 to 0.162) |
| Cameroong | 1.037 (0.978–1.095) | 1.060 (1.000–1.117) | 0.964 (0.909–1.020) | 0.023 (− 0.060 to 0.106) | − 0.073 (− 0.153 to 0.008) |
| Senegalh | 1.201 (1.078–1.309) | 1.063 (0.920–1.207) | 1.022 (0.853–1.177) | − 0.138 (− 0.319 to 0.049) | − 0.179 (− 0.381 to 0.018) |
| ICER (∆Costs/∆QALYs) | |||||
| Burkina Fasof | ICER = 19,674* | ICER = 17,693* | |||
| Cameroong | ICER = 23,470* | Arm A Dominantc* | |||
| Senegalh | Arm A Dominantc* | Arm A Dominantc* | |||
| Scenario 1 (2018 MSF prices of ARVd) | |||||
| Total costs per patient (USD) | |||||
| Burkina Fasof | 1036 (1008–1053) | 1457 (1333–1542) | 1503 (1462–1533) | 421 (294–512) | 468 (422–509) |
| Cameroong | 1247 (1209–1282) | 1752 (1686–1807) | 1698 (1645–1741) | 505 (431–573) | 451 (388–509) |
| Senegalh | 1403 (1338–1453) | 1988 (1949–2026) | 1806 (1576–1993) | 585 (520–659) | 402 (168–602) |
| QALYs per patient | |||||
| Burkina Fasof | 1.098 (1.003–1.192) | 1.119 (0.989–1.232) | 1.126 (1.030–1.218) | 0.021 (− 0.140 to 0.169) | 0.028 (− 0.107 to 0.162) |
| Cameroong | 1.037 (0.978–1.095) | 1.060 (1.000–1.117) | 0.964 (0.909–1.020) | 0.023 (− 0.060 to 0.106) | − 0.073 (− 0.153 to 0.008) |
| Senegalh | 1.201 (1.078–1.309) | 1.063 (0.920–1.207) | 1.022 (0.853–1.177) | − 0.138 (− 0.319 to 0.049) | − 0.179 (− 0.381 to 0.018) |
| ICER (∆Costs/∆QALYs) | |||||
| Burkina Fasof | ICER = 21,050* | ICER = 17,682* | |||
| Cameroong | ICER = 23,198* | Arm A Dominantc* | |||
| Senegalh | Arm A Dominantc* | Arm A Dominantc* | |||
| Scenario 2 (LYS) | |||||
| Total costs per patient (USD) | |||||
| Burkina Fasof | 1085 (1056–1104) | 1496 (1367–1584) | 1573 (1529–1604) | 410 (280–504) | 488 (439–532) |
| Cameroong | 1352 (1308–1396) | 1884 (1804–1961) | 1820 (1760–1873) | 532 (441–621) | 468 (395–538) |
| Senegalh | 1461 (1396–1511) | 2183 (2103–2258) | 2008 (1751–2216) | 721 (626–819) | 546 (283–764) |
| LYS per patient | |||||
| Burkina Fasof | 1.898 (1.820–1.944) | 1.823 (1.657–1.930) | 1.921 (1.888–1.939) | − 0.075 (− 0.249 to 0.064) | 0.023 (− 0.038 to 0.107) |
| Cameroong | 1.882 (1.825–1.928) | 1.892 (1.823–1.946) | 1.901 (1.842–1.945) | 0.009 (− 0.073 to 0.088) | 0.018 (− 0.058 to 0.093) |
| Senegalh | 1.908 (1.802–1.968) | 1.956 (1.935–1.971) | 1.791 (1.551–1.959) | 0.048 (− 0.020 to 0.159) | − 0.117 (− 0.361 to 0.092) |
| ICER (∆Costs/∆LYS) | |||||
| Burkina Fasof | Arm A Dominantc* | ICER = 21,048* | |||
| Cameroong | ICER = 56,450* | ICER = 25,729* | |||
| Senegalh | ICER = 15,018* | Arm A Dominantc* | |||
| Scenario 3 (QALYse) | |||||
| Total costs per patient (USD) | |||||
| Burkina Fasof | 1085 (1056–1104) | 1496 (1367–1584) | 1573 (1529–1604) | 410 (280–505) | 488 (439–532) |
| Cameroong | 1352 (1308–1396) | 1884 (1804–1961) | 1820 (1760–1873) | 532 (441–621) | 468 (395–538) |
| Senegalh | 1461 (1396–1511) | 2183 (2103–2258) | 2008 (1751–2216) | 721 (626–819) | 546 (283–764) |
| QALYs per patient | |||||
| Burkina Fasof | 1.611 (1.534–1.678) | 1.581 (1.428–1.692) | 1.632 (1.571–1.688) | − 0.030 (− 0.196 to 0.108) | 0.021 (− 0.070 to 0.117) |
| Cameroong | 1.564 (1.508–1.613) | 1.584 (1.521–1636) | 1.534 (1.480–1.582) | 0.020 (− 0.059 to 0.097) | − 0.030 (− 0.103 to 0.044) |
| Senegalh | 1.670 (1.556–1.753) | 1.613 (1.525–1.699) | 1.511 (1.301–1.675) | − 0.057 (− 0.182 to 0.084) | − 0.159 (− 0.386 to 0.041) |
| ICER (∆Costs/∆QALYs) | |||||
| Burkina Fasof | Arm A Dominantc* | ICER = 23,358* | |||
| Cameroong | ICER = 26,716* | Arm A Dominantc* | |||
| Senegalh | Arm A Dominantc* | Arm A Dominantc* | |||
| Scenario 4a (discount rate of 0%) | |||||
| Total costs per patient (USD) | |||||
| Burkina Fasof | 1100 (1069–1119) | 1516 (1386–1607) | 1596 (1551–1628) | 417 (284–513) | 496 (447–541) |
| Cameroong | 1369 (1324–1415) | 1911 (1829–1989) | 1846 (1785–1900) | 542 (449–632) | 477 (402–548) |
| Senegalh | 1479 (1412–1531) | 2214 (2131–2290) | 2035 (1773–2248) | 735 (636–834) | 556 (288–781) |
| QALYs per patient | |||||
| Burkina Fasof | 1.118 (1.020–1.214) | 1.139 (1.005–1.254) | 1.146 (1.048–1.239) | 0.0214 (− 0.143 to 0.174) | 0.0282 (− 0.110 to 0.164) |
| Cameroong | 1.056 (0.995–1.115) | 1.079 (1.019–1.138) | 0.981 (0.925–1.038) | 0.0236 (− 0.061 to 0.109) | − 0.0743 (− 0.156 to 0.008) |
| Senegalh | 1.223 (1.098–1.333) | 1.082 (0.937–1.227) | 1.040 (0.867–1.198) | − 0.1409 (− 0.324 to 0.051) | − 0.1826 (− 0.390 to 0.020) |
| ICER (∆Costs/∆QALYs) | |||||
| Burkina Fasof | ICER = 19,465* | ICER = 17,615* | |||
| Cameroong | ICER = 22,963* | Arm A Dominantc* | |||
| Senegalh | Arm A Dominantc* | Arm A Dominantc* | |||
| Scenario 4b (discount rate of 6%) | |||||
| Total costs per patient (USD) | |||||
| Burkina Fasof | 1076 (1047–1094) | 1482 (1354–1569) | 1558 (1515–1589) | 406 (275–499) | 482 (434–526) |
| Cameroong | 1340 (1297–1384) | 1866 (1787–1942) | 1803 (1744–1855) | 526 (436–613) | 463 (390–531) |
| Senegalh | 1449 (1386–1498) | 2162 (2082–2236) | 1989 (1735–2197) | 713 (617–809) | 540 (278–755) |
| QALYs per patient | |||||
| Burkina Fasof | 1.085 (0.991–1.178) | 1.106 (0.976–1.217) | 1.113 (1.018–1.203) | 0.0205 (− 0.139 to 0.168) | 0.0272 (− 0.105 to 0.157) |
| Cameroong | 1.025 (0.966–1.082) | 1.047 (0.988–1.104) | 0.952 (0.898–1.007) | 0.0221 (− 0.059 to 0.105) | − 0.0723 (− 0.151 to 0.008) |
| Senegalh | 1.186 (1.066–1.294) | 1.050 (0.910–1.193) | 1.009 (0.843–1.164) | − 0.1364 (− 0.317 to 0.050) | − 0.1767 (− 0.376 to 0.018) |
| ICER (∆Costs/∆QALYs) | |||||
| Burkina Fasof | ICER = 19,823* | ICER = 17,750* | |||
| Cameroong | ICER = 23,834* | Arm A Dominantc* | |||
| Senegalh | Arm A Dominantc* | Arm A Dominantc* | |||
ABC ddI LPV/r abacavir + didanosine + lopinavir/ritonavir, ARV antiretroviral drugs, CI confidence interval, ICER incremental cost-effectiveness ratio, LYS life-year saved, MSF Médecins Sans Frontières, QALYs quality-adjusted life-years, TDF/FTC DRV/r tenofovir/emtricitabine + darunavir/ritonavir, TDF/FTC LPV/r tenofovir/emtricitabine + lopinavir/ritonavir, USD United States dollars, ∆ difference
*The probability of arm A being cost-effective at one times the country’s per capita gross domestic product is 100%
aUnit prices of antiretroviral drugs for the year 2016 (obtained from the WHO Global Price Reporting Mechanism database)
bEstimates of utilities were obtained from the DART trial [16]
cDominance means significant lower costs and higher QALYs
dUnit prices of antiretroviral drugs for the year 2018 (obtained from the Médecins Sans Frontières report [30]
eEstimates of utilities were obtained from Tengs and Lin [31]
fn = 90 (30 in arm A, 28 in arm B and 32 in arm C)
gn = 302 (101 in arm A, 99 in arm B and 102 in arm C)
hn = 59 (21 in arm A, 18 in arm B and 20 in arm C)