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Cost-minimisation analysis of the use of etravirine or raltegravir in treatment-experienced HIV-1-infected patients

Purpose of the study

HIV treatment guidelines state that the goal of highly active antiretroviral therapy (HAART) is to achieve an undetectable viral load (VL; <50 copies/mL) in HIV-infected patients. Two new therapies, etravirine (ETR; TMC125) and raltegravir (RAL), have recently been approved in the US, both with similar indications for treatment-experienced HIV-1-infected patients. This analysis compared the relative cost of reaching this treatment goal for each therapy.


The proportion of patients achieving undetectable VL (<50 copies/mL) was reported in Phase III trials that compared ETR (DUET-1 & 2) or RAL (BENCHMRK 1 & 2) to placebo, both in the presence of a background regimen (BR). ETR and RAL have not been compared in head-to-head trials, so an indirect comparison of efficacy and cost of treatment at week 24 was made. In both sets of trials, patients were treatment-experienced, but the composition of the BR differed. In DUET, all patients received darunavir/ritonavir (DRV/r) as part of their BR, while in the BENCHMRK trials less than half of the patients received background DRV/r. Subgroup data from BENCHMRK provided a 'prior' estimate of the treatment effect modification due to DRV/r use. A Bayesian analysis was used, which adjusted for differences in background DRV/r use between trials. The current analysis estimated the treatment effect assuming that all patients received background DRV/r. After adjusting for differences in the trials, efficacy and US wholesale acquisition drug costs were analysed.

Summary of results

ETR and RAL demonstrated a similar treatment effect when adjusting for differences in the BR. Mean odds ratios (95% confidence interval) vs. placebo were 2.08 (1.64–2.6) and 1.92 (0.98–3.42) for ETR and RAL, respectively. Annual drug costs were calculated to be $7,957 for ETR and $9,855 for RAL.


Both ETR and RAL showed similar efficacy rates in achieving undetectable VL. As a result, a cost-minimisation approach can be taken when evaluating the addition of ETR or RAL to a HAART regimen for treatment-experienced HIV-1-infected patients.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Martin, S., Smets, E. Cost-minimisation analysis of the use of etravirine or raltegravir in treatment-experienced HIV-1-infected patients. JIAS 11 (Suppl 1), P316 (2008).

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