Overall, the two first-line antiretroviral regimens recommended by the World Health Organization (i.e. dolutegravir 50 mg [DTG]-based and low-dose [400 mg] efavirenz [EFV400]-based regimens) provided similar patient-reported outcomes (including perceived symptoms, depression, anxiety, and mental and physical quality of life) over the first 96 weeks of follow-up in HIV-1-positive patients enrolled in the randomised NAMSAL ANRS 12313 trial in Cameroon.

Despite the higher risk of obesity associated with DTG, which in turn may impair quality of life, the base-case analysis over 96 weeks showed that the DTG-based regimen was the preferred first-line regimen, with a net health benefit of 0.056 (− 0.037 to 0.153), corresponding to a cost-effectiveness probability of 88% at the threshold of US$500 per quality-adjusted life-year gained.

When extrapolating the outcomes over 5 and 10 years, the cost-effectiveness of the DTG-based first-line regimen further improved, with a ≥ 95% probability of being cost-effective for a large range of cost-effectiveness thresholds (from US$0 to US$5147 over 10 years) thanks to both the lower virological failure risk (using the World Health Organization definition) and lower acquired drug resistance observed in the DTG arm compared with in the EFV400 arm, resulting in turn in higher long-term health benefits and lower costs.