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Type: Journal article
Title: The potential cost and benefits of raltegravir in simplified second-line therapy among HIV Infected Patients in Nigeria and South Africa
Author: Schneider, K.
Nwizu, C.
Kaplan, R.
Anderson, J.
Wilson, D.
Emery, S.
Cooper, D.
Boyd, M.
Citation: PLoS One, 2013; 8(2):e54435-e54435
Publisher: PLOS ONE
Issue Date: 2013
ISSN: 1932-6203
Editor: Sluis-Cremer, N.
Statement of
Karen Schneider, Chidi Nwizu, Richard Kaplan, Jonathan Anderson, David P. Wilson, Sean Emery, David A. Cooper, Mark A. Boyd
Abstract: BACKGROUND: There is an urgent need to improve the evidence base for provision of second-line antiretroviral therapy (ART) following first-line virological failure. This is particularly the case in Sub-Saharan Africa where 70% of all people living with HIV/AIDS (PHA) reside. The aim of this study was to simulate the potential risks and benefits of treatment simplification in second-line therapy compared to the current standard of care (SOC) in a lower-middle income and an upper-middle income country in Sub-Saharan Africa. METHODS: We developed a microsimulation model to compare outcomes associated with reducing treatment discontinuations between current SOC for second-line therapy in South Africa and Nigeria and an alternative regimen: ritonavir-boosted lopinavir (LPV/r) combined with raltegravir (RAL). We used published studies and collaborating sites to estimate efficacy, adverse effect and cost. Model outcomes were reported as incremental cost effectiveness ratios (ICERs) in 2011 USD per quality adjusted life year ($/QALY) gained. RESULTS: Reducing treatment discontinuations with LPV/r+RAL resulted in an additional 0.4 discounted QALYs and increased the undiscounted life expectancy by 0.8 years per person compared to the current SOC. The average incremental cost was $6,525 per treated patient in Nigeria and $4,409 per treated patient in South Africa. The cost-effectiveness ratios were $16,302/QALY gained and $11,085/QALY gained for Nigeria and South Africa, respectively. Our results were sensitive to the probability of ART discontinuation and the unit cost for RAL. CONCLUSIONS: The combination of raltegravir and ritonavir-boosted lopinavir was projected to be cost-effective in South Africa. However, at its current price, it is unlikely to be cost-effective in Nigeria.
Keywords: Antiretroviral therapy; cost-effectiveness analysis; T cells; adverse events; drug therapy; Africa; HIV; randomized controlled
Rights: © 2013 Schneider et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI: 10.1371/journal.pone.0054435
Grant ID: ARC
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