January 08, 2016
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Tivicay/lamivudine regimen more cost-effective than standard ART

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Administering a two-drug Tivicay/lamivudine regimen to half of potentially eligible ART-naive HIV-infected individuals could save more than $500 million in treatment costs over 5 years in the United States, provided it demonstrates high rates of virologic suppression, according to a study published in Clinical Infectious Diseases.

Two pilot studies are currently investigating the two-drug regimen of Tivicay (dolutegravir, ViiV Healthcare), an FDA-approved integrase strand transfer inhibitor; and lamivudine as both initial and maintenance therapy, according to Michael P. Girouard, MD, from the Medical Practice Evaluation Center and the division of general internal medicine at Massachusetts General Hospital, and colleagues. Results are anticipated early this year.

To examine the potential cost-effectiveness and financial impact of dolutegravir and lamivudine, first-line ART regimens in the U.S., Girouard and colleagues used simulation modeling to project the clinical and economic outcomes of patients who were ART-naive under four treatment strategies. The strategies were:

  • No ART, for modeling comparison;
  • an initial, two-drug regimen of dolutegravir/lamivudine;
  • a 48-week induction of the three-drug combination Triumeq (dolutegravir/abacavir/lamivudine, ViiV Healthcare), followed by dolutegravir/lamivudine maintenance if virologically suppressed; and
  • the standard-of-care, three-drug regimen of dolutegravir/abacavir/lamivudine.

The researchers considered a strategy cost-effective if its incremental cost-effectiveness ratio (ICER) was less than $100,000 per quality-adjusted life-year (QALY).

They estimated that all three ART regimens had 90% survival rates over a 5-year period. The ICER for the 48-week induction regimen was $22,500 per QALY, compared with more than $500,000 per QALY for the standard-of-care strategy. The initial two-drug regimen proved to be the preferred strategy only when the virologic suppression rate exceeded 90%.

With 50% uptake of either the 48-week or two-drug strategies for patients who are ART-naive, cost savings totaled $550 million and $800 million, respectively, over the course of 5 years. If 25% of currently suppressed patients were switched to dolutegravir/lamivudine maintenance, cost savings could reach more than $3 billion, the researchers said.

“Using a mathematical simulation of HIV disease and treatment, we demonstrate that an induction-maintenance strategy of three-drug initial therapy with [dolutegravir/abacavir/lamivudine] followed by [dolutegravir/lamivudine] maintenance would be cost-effective in the U.S. under plausible virologic efficacy assumptions; [dolutegravir/lamivudine] as initial therapy could be even more cost-effective,” Girouard and colleagues concluded. “The difference between these two DTG+3TC strategies depends on whether [dolutegravir/lamivudine] can achieve sufficiently high levels of initial virologic suppression.” – by Jason Laday

Disclosure: Girouard reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.