Cost-effectiveness analysis of efavirenz versus ainuovirine in people living with HIV initiating first-line combination antiretroviral therapy.

چکیده اصلی

BACKGROUND: Ainuovirine (ANV), a new non-nucleoside reverse transcriptase inhibitor, has been shown to have comparable effectiveness to efavirenz (EFV) with fewer adverse events. However, evidence on the cost-effectiveness of replacing EFV-based regimens with ANV-based regimens remains limited, particularly within the context of China's National Free Antiretroviral Treatment Programme. OBJECTIVE: This study aimed to evaluate the cost-effectiveness of ANV-based versus EFV-based regimens among people living with HIV (PLWH) in China. METHODS: Decision tree-Markov models were developed to compare EFV-based and ANV-based regimens over a 15-year time horizon from a societal perspective. Model inputs, including treatment costs and adverse event risks, were mainly obtained from a multicentre Chinese cohort and field survey data. Cost-effectiveness was assessed separately for treatment-naïve and treatment-experienced populations and at the overall programme level. Outcomes included costs, quality-adjusted life-years (QALYs), adverse events and incremental cost-effectiveness ratios (ICERs). One-way, probabilistic and scenario sensitivity analyses were conducted to assess parameter and structural uncertainty. RESULTS: Compared with the EFV-based regimen, ANV-based regimen was associated with a marked reduction in cumulative adverse events, while producing small per-person QALY gains of 0.006-0.011 at modestly higher costs across the modelled populations. ANV-based regimens generated slightly higher QALYs at modestly higher costs across all modelled populations. The ICERs were $10 030.41/QALY in treatment-naïve individuals, $3881.06/QALY in treatment-experienced individuals and $5146.18/QALY at the overall programme level, all below the prespecified willingness-to-pay threshold of three times China's 2019 per-capita gross domestic product ($30 793.15/QALY). Sensitivity analyses showed that the results were robust, with ANV and EFV medication costs being the most influential parameters. If the half-year cost of ANV medication decreased below $361.39, the ANV-based regimen would become the dominant strategy, providing greater health benefits at lower overall costs. CONCLUSION: Within the context of China's National Free Antiretroviral Treatment Programme, ANV-based regimens were cost-effective compared with EFV-based regimens among PLWH, with reduced adverse events and modest QALY gains at acceptable incremental costs. These findings support consideration of ANV-based regimens as an alternative option in future procurement and price negotiation decisions.

ترجمه فارسی چکیده

آینوویرین (ANV)، یک مهارکننده رونوشت‌بردار معکوس غیرقابل‌حل‌شونده جدید، اثربخشی مشابهی با ائفاویرنز (EFV) و رویدادهای نامطلوب کمتری دارد. این مطالعه به ارزیابی هزینه‌های اثربخشی رژیم‌های مبتنی بر ANV در برابر EFV در چین با استفاده از مدل‌های تصمیم‌درخت و مارکوف طی افق زمانی ۱۵ ساله پرداخت. نتایج نشان داد رژیم‌های مبتنی بر ANV با هزینه‌های کمی بیشتر، منجر به کاهش رویدادهای نامطلوب و کسب کمی QALY می‌شوند. نسبت‌های هزینه‌های اثربخشی افزوده (ICER) زیر آستانه پذیرش هزینه (۳ برابر GDP سرانه چین در سال ۲۰۱۹) بودند. اگر هزینه نیم‌سالانه داروی ANV زیر ۳۶۱.۳۹ دلار کاهش یابد، رژیم مبتنی بر ANV استراتژی غالب خواهد بود.

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