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Colegio de Medicina Interna de México.

2010, Number 3

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Med Int Mex 2010; 26 (3)

Cost-effectiveness of maraviroc plus optimized basetreatment in patients with HIV/AIDS

Contreras HI, Mould JF, Rely K, Garduño EJ

Language: Spanish
References: 35
Page: 199-206
PDF size: 135.66 Kb.


ABSTRACT

Objective: To estimate the cost-effectiveness of maraviroc plus optimized baseline treatment (OBT) in comparison to optimized baseline treatment alone in patients with HIV/AIDS.
Material and methods: A Markov model was used to estimate the free months to virologic failure, disease-progression free months, Quality adjusted life-years gained (QALYs) and costs. Model simulates the addition of maraviroc to optimized baseline treatment in comparison to optimized baseline treatment alone for antiretroviral multi-resistant patients with HIV/AIDS with positive CCR5. The model includes six-month cycles among several health-states: Non virologic failure, virologic failure, disease progression and death for a 5 years time horizon. Transition probabilities were obtained from MOTIVATE and ART Cohort Collaboration studies. Costs were calculated from a patient simple with HIV/AIDS at the Social Security Mexican Institute (IMSS) (n=637), and were adjusted to 2009 Mexican pesos and further express into US dollars (13.15 MX$/US$). A 5% discount rate was employed and probabilistic sensitivity analysis was performed.
Results: Adding maraviroc to optimized baseline treatment showed to increase the number of free months to virologic failure (24.5 vs. 7.5 months); disease-progression free months (56.1 vs. 34.5 months) and QALYs (4.29 vs. 2.96). Mean expected costs per patient resulted higher for the maraviroc +optimized baseline treatment arm (US$52,683.76 vs. US$27,550.14). The cost of adding maraviroc to obtain an additional month of free months to virologic failure resulted in US$ 1,477.57, with disease-progression free months in US$1,163.59 and for each QALY in US$18,897.44.
Conclusions: Adding maraviroc to optimized baseline treatment for antiretroviral multi-resistant patients with HIV/AIDS with positive CCR5, showed better clinical results with a higher cost. In concordance with international thresholds maraviroc plus optimized baseline treatment would be consider a cost-effective alternative.


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