Table 1.
Multivariate-adjusted QALYs, costs (US$, year 2016 values) and cost-effectiveness (NAMSAL ANRS 12313 trial, n = 575)
| EFV400-based regimen (n = 300) | DTG-based regimen (n = 275) | Differences (DTG vs EFV400) | NHB | Prob(DTG:CE) | |
|---|---|---|---|---|---|
| Base-case analysis | |||||
| Total cost per patient | 982.8 (899.8–1065.7) | 955.0 (872.0–1037.9) | −27.8 (−72.1 to 16.6) | 0.056 (−0.037 to 0.153) | 88% |
| QALYs per patient | 1.367 (1.248–1.486) | 1.368 (1.249–1.486) | 0.000 (−0.034 to 0.035) | ||
| Alternative scenarios | |||||
| Discount rate of 0% | |||||
| Total cost per patient | 1016.8 (929.3–1104.3) | 988.0 (900.5–1075.5) | −28.8 (−74.4 to 16.9) | 0.059 (−0.037 to 0.160) | 89% |
| QALYs per patient | 1.436 (1.309–1.562) | 1.437 (1.311–1.564) | 0.002 (−0.034 to 0.038) | ||
| Discount rate of 6% | |||||
| Total cost per patient | 951.4 (872.5–1030.3) | 924.6 (845.7–1003.5) | −26.8 (−70.0 to 16.4) | 0.053 (−0.037 to 0.148) | 87% |
| QALYs per patient | 1.304 (1.192–1.416) | 1.304 (1.192–1.416) | −0.001 (−0.033 to 0.032) | ||
| Intention-to-treat population (n = 613) | |||||
| Total cost per patient | 984.4 (903.2–1065.6) | 954.2 (873.0–1035.4) | −30.2 (−72.0 to 11.7) | 0.055 (−0.033 to 0.147) | 89% |
| QALYs per patient | 1.368 (1.256–1.481) | 1.363 (1.250–1.475) | −0.005 (−0.038 to 0.028) | ||
| Patients with > 100,000 copies/mL HIV RNA load only (n = 379) | |||||
| Total cost per patient | 1005.8 (942.6–1,069.0) | 951.7 (888.5–1014.9) | −54.1 (−112.7 to 4.5) | 0.092 (−0.031 to 0.221) | 92% |
| QALYs per patient | 1.370 (1.238–1.502) | 1.354 (1.222–1.486) | −0.017 (−0.062 to 0.030) | ||
| Markov cohort simulation model | |||||
| Over 5 years | |||||
| Total cost per patient | 2140.4 (2106.3–2171.6) | 2041.3 (2010.2–2076.3) | −99.1 (−142.3 to −51.8) | 0.194 (0.123–0.261) | 100% |
| QALYs per patient | 3.440 (3.397–3.482) | 3.436 (3.395–3.474) | −0.005 (−0.061 to 0.052) | ||
| Over 10 years | |||||
| Total cost per patient | 3831.1 (3710.3–3929.7) | 3669.6 (3546.6–3764.9) | −161.5 (−314.6 to −5.8) | 0.484 (0.341–0.622) | 100% |
| QALYs per patient | 6.270 (6.076–6.438) | 6.431 (6.212–6.576) | 0.161 (−0.097 to 0.404) | ||
Data are presented as mean values (95% confidence interval). Covariates for the multivariate-adjusted models were gender, age, CD4 count, HIV RNA level, and utilities at baseline. 95% confidence intervals for the costs and QALYs differences, the NHB, and the Prob(DTG:CE) were computed based on 5000 bootstrap replicates. Cost-effectiveness threshold: $500 per QALY gained
DTG dolutegravir, EFV400 efavirenz 400 mg, HIV human immunodeficiency virus, NAMSAL New Antiretroviral and Monitoring Strategies in HIV-infected Adults in Low-Income Countries, NHB net health benefit, Prob(DTG:CE) probability of DTG being cost-effective at the $500 threshold, QALY quality-adjusted life-year