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Cost-effectiveness of atazanavir-ritonavir versus lopinavir-ritonavir in HIV patients initiating first-line antiretroviral therapy
© Juday et al; licensee BioMed Central Ltd. 2010
Published: 8 November 2010
Purpose of the study
Selection of initial antiretroviral therapy (ART) may be informed by factors such as efficacy, adverse effects, and cost. This study assessed the lifetime cost-effectiveness of atazanavir-ritonavir (ATV/r) versus lopinavir-ritonavir (LPV/r) in HIV patients initiating first-line ART.
A Markov microsimulation model was developed to project lifetime health-related outcomes, costs, quality-adjusted life years (QALYs), and cost-effectiveness of ATV/r versus LPV/r, both with tenofovir-emtricitabine, as first-line ART. Virologic suppression, baseline characteristics, state transition probabilities, cholesterol changes, and adverse effects were based on 96-week CASTLE results. HIV-related mortality, opportunistic infection (OI) and AIDS rates, coronary heart disease (CHD) risk, treatment adherence, costs, and utilities were obtained from published sources. Costs were reported in 2009 US dollars. Sensitivity analyses were conducted to assess the robustness of study results.
Summary of results
Time on First-Line Treatment (months)
AIDS cases (per 1000 patient years)
OI cases (per 1000 patient years)
CHD cases (per 1000 patient years)
Diarrhea cases (per 1000 patient years)
HB cases (per 1000 patient years)
Absolute Survival (life years)
Cost, QALY, and Cost-Effectiveness
Quality-Adjusted Survival (QALY)
Accounting for both lifetime costs and QALYs, ATV/r is cost effective (less than $50,000 per QALY) compared with LPV/r in HIV patients initiating first-line ART.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.