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Economic evaluation of weekends-off antiretroviral therapy for young people in 11 countries

Tierrablanca, LE; Ochalek, J; Ford, D; Babiker, A; Gibb, D; Butler, K; Turkova, A; ... BREATHER (PENTA 16) Trial Group; + view all (2018) Economic evaluation of weekends-off antiretroviral therapy for young people in 11 countries. Medicine , 97 (5) , Article e9698. 10.1097/MD.0000000000009698. Green open access

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Abstract

OBJECTIVES: To analyze the cost effectiveness of short-cycle therapy (SCT), where patients take antiretroviral (ARV) drugs 5 consecutive days a week and have 2 days off, as an alternative to continuous ARV therapy for young people infected with human immunodeficiency virus (HIV) and taking efavirenz-based first-line ARV drugs. METHODS: We conduct a hierarchical cost-effectiveness analysis based on data on clinical outcomes and resource use from the BREATHER trial. BREATHER is a randomized trial investigating the effectiveness of SCT and continuous therapy in 199 participants aged 8 to 24 years and taking efavirenz-based first-line ARV drugs in 11 countries worldwide. Alongside nationally representative unit costs/prices, these data were used to estimate costs and quality adjusted life years (QALYs). An incremental cost-effectiveness comparison was performed using a multilevel bivariate regression approach for total costs and QALYs. Further analyses explored cost-effectiveness in low- and middle-income countries with access to low-cost generic ARV drugs and high-income countries purchasing branded ARV drugs, respectively. RESULTS: At 48 weeks, SCT offered significant total cost savings over continuous therapy of US dollar (USD) 41 per patient in countries using generic drugs and USD 4346 per patient in countries using branded ARV drugs, while accruing nonsignificant total health benefits of 0.008 and 0.009 QALYs, respectively. Cost-effectiveness estimates were similar across settings with access to generic ARV drugs but showed significant variation among high-income countries where branded ARV drugs are purchased. CONCLUSION: SCT is a cost-effective treatment alternative to continuous therapy for young people infected with HIV in countries where viral load monitoring is available.

Type: Article
Title: Economic evaluation of weekends-off antiretroviral therapy for young people in 11 countries
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/MD.0000000000009698
Publisher version: http://dx.doi.org/10.1097/MD.0000000000009698
Language: English
Additional information: © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Adolescent, Anti-HIV Agents, Benzoxazines, Child, Cost-Benefit Analysis, Drug Administration Schedule, Drugs, Generic, Follow-Up Studies, HIV Infections, Health Care Costs, Humans, Internationality, Quality-Adjusted Life Years, Regression Analysis, Treatment Outcome, Viral Load, Young Adult
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10044168
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