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Cost-effectiveness of tipranavir versus comparator protease inhibitor regimens in HIV infected patients previously exposed to antiretroviral therapy in the Netherlands.

Hubben GA, Bos JM, Veltman-Starkenburg CA, Stegmeijer S, Finnern HW, Kappelhoff BS, Simpson KN, Tramarin A, Postma MJ - Cost Eff Resour Alloc (2007)

Bottom Line: We compared the projected lifetime costs and effects of two theoretical groups of 1000 patients, one receiving a standard of care regimen with TPV/r as a component and the other receiving a standard of care regimen with CPI/r.The accumulated discounted effect is 7.43 life years or 6.31 quality adjusted life years (QALYs) per patient receiving TPV/r, compared to 6.91 life years or 5.80 QALYs per patient receiving CPI/r.The corresponding incremental cost effectiveness ratios (iCERs) are euro41,600 per LYG and euro42,500 per QALY.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Center for Pharmacy, University of Groningen, The Netherlands. g.hubben@rug.nl

ABSTRACT

Background: This study compares the costs and effects of a regimen with ritonavir-boosted tipranavir (TPV/r) to a physician-selected genotypically-defined standard-of-care comparator protease inhibitor regimen boosted with ritonavir (CPI/r) in HIV infected patients that were previously exposed to antiretroviral therapy in the Netherlands.

Methods: We compared the projected lifetime costs and effects of two theoretical groups of 1000 patients, one receiving a standard of care regimen with TPV/r as a component and the other receiving a standard of care regimen with CPI/r. A 3-stage Markov model was formulated to represent three different consecutive HAART regimens. The model uses 12 health states based on viral load and CD4+ count to simulate disease progression. The transition probabilities for the Markov model were derived from a United States cohort of treatment experienced HIV patients. Furthermore, the study design was based on 48-week data from the RESIST-2 clinical trial and local Dutch costing data. Cost and health effects were discounted at 4% and 1.5% respectively according to the Dutch guideline. The analysis was conducted from the Dutch healthcare perspective using 2006 unit cost prices.

Results: Our model projects an accumulated discounted cost to the Dutch healthcare system per patient receiving the TPV/r regimen of euro167,200 compared to euro145,400 for the CPI/r regimen. This results in an incremental cost of euro21,800 per patient. The accumulated discounted effect is 7.43 life years or 6.31 quality adjusted life years (QALYs) per patient receiving TPV/r, compared to 6.91 life years or 5.80 QALYs per patient receiving CPI/r. This translates into an incremental effect of TPV/r over CPI/r of 0.52 life years gained (LYG) or 0.51 QALYs gained. The corresponding incremental cost effectiveness ratios (iCERs) are euro41,600 per LYG and euro42,500 per QALY.

Conclusion: We estimated the iCER for TPV/r compared to CPI/r at approximately euro40,000 in treatment experienced HIV-1 infected patients in the Netherlands. This ratio may well be in range of what is acceptable and warrants reimbursement for new drug treatments in the Netherlands, in particular in therapeutic areas as end-stage oncology and HIV and other last-resort health-care interventions.

No MeSH data available.


Related in: MedlinePlus

Tornado diagram of the sensitivity analysis. Tornado diagram of the univariate sensitivity analysis showing the impact of individual cost parameters on the iCER per QALY. Parameter values of 75% and 125% of the base-case value were evaluated and these values are shown on both sides of the bars. All parameters refer to costs and are expressed in Euro price level 2006. TPV/r tipranavir with ritonavir. CPI/r comparator protease inhibitor with ritonavir. HAART highly active antiretroviral therapy. iCER incremental cost effectiveness ratio. QALY quality adjusted life year.
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Figure 2: Tornado diagram of the sensitivity analysis. Tornado diagram of the univariate sensitivity analysis showing the impact of individual cost parameters on the iCER per QALY. Parameter values of 75% and 125% of the base-case value were evaluated and these values are shown on both sides of the bars. All parameters refer to costs and are expressed in Euro price level 2006. TPV/r tipranavir with ritonavir. CPI/r comparator protease inhibitor with ritonavir. HAART highly active antiretroviral therapy. iCER incremental cost effectiveness ratio. QALY quality adjusted life year.

Mentions: The results of the univariate sensitivity analysis on cost parameters are presented in figure 2. This tornado diagram ranks the cost parameters based on the magnitude of their impact on the iCER per QALY. The diagram shows clearly that the regimen costs of both arms have the highest impact on the model outcome. For the remaining cost parameters, the model proved to be robust to changes. Multiplying all AIDS event rates simultaneously by 0.75 and 1.25 had a relatively low impact on the iCER of €42,800 and €42,200 per QALY, respectively. Additionally, the discount rates were evaluated at 0% and 5%. This resulted in €51,600 and €40,700 per QALY for the discount rate for costs, and €37,900 and €54,300 per QALY for the discount rate for effects, respectively. The impact of a 5% slower and faster disease progression on the iCER was modest with €41,300 and €43,700 per QALY, respectively.


Cost-effectiveness of tipranavir versus comparator protease inhibitor regimens in HIV infected patients previously exposed to antiretroviral therapy in the Netherlands.

Hubben GA, Bos JM, Veltman-Starkenburg CA, Stegmeijer S, Finnern HW, Kappelhoff BS, Simpson KN, Tramarin A, Postma MJ - Cost Eff Resour Alloc (2007)

Tornado diagram of the sensitivity analysis. Tornado diagram of the univariate sensitivity analysis showing the impact of individual cost parameters on the iCER per QALY. Parameter values of 75% and 125% of the base-case value were evaluated and these values are shown on both sides of the bars. All parameters refer to costs and are expressed in Euro price level 2006. TPV/r tipranavir with ritonavir. CPI/r comparator protease inhibitor with ritonavir. HAART highly active antiretroviral therapy. iCER incremental cost effectiveness ratio. QALY quality adjusted life year.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2211743&req=5

Figure 2: Tornado diagram of the sensitivity analysis. Tornado diagram of the univariate sensitivity analysis showing the impact of individual cost parameters on the iCER per QALY. Parameter values of 75% and 125% of the base-case value were evaluated and these values are shown on both sides of the bars. All parameters refer to costs and are expressed in Euro price level 2006. TPV/r tipranavir with ritonavir. CPI/r comparator protease inhibitor with ritonavir. HAART highly active antiretroviral therapy. iCER incremental cost effectiveness ratio. QALY quality adjusted life year.
Mentions: The results of the univariate sensitivity analysis on cost parameters are presented in figure 2. This tornado diagram ranks the cost parameters based on the magnitude of their impact on the iCER per QALY. The diagram shows clearly that the regimen costs of both arms have the highest impact on the model outcome. For the remaining cost parameters, the model proved to be robust to changes. Multiplying all AIDS event rates simultaneously by 0.75 and 1.25 had a relatively low impact on the iCER of €42,800 and €42,200 per QALY, respectively. Additionally, the discount rates were evaluated at 0% and 5%. This resulted in €51,600 and €40,700 per QALY for the discount rate for costs, and €37,900 and €54,300 per QALY for the discount rate for effects, respectively. The impact of a 5% slower and faster disease progression on the iCER was modest with €41,300 and €43,700 per QALY, respectively.

Bottom Line: We compared the projected lifetime costs and effects of two theoretical groups of 1000 patients, one receiving a standard of care regimen with TPV/r as a component and the other receiving a standard of care regimen with CPI/r.The accumulated discounted effect is 7.43 life years or 6.31 quality adjusted life years (QALYs) per patient receiving TPV/r, compared to 6.91 life years or 5.80 QALYs per patient receiving CPI/r.The corresponding incremental cost effectiveness ratios (iCERs) are euro41,600 per LYG and euro42,500 per QALY.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Center for Pharmacy, University of Groningen, The Netherlands. g.hubben@rug.nl

ABSTRACT

Background: This study compares the costs and effects of a regimen with ritonavir-boosted tipranavir (TPV/r) to a physician-selected genotypically-defined standard-of-care comparator protease inhibitor regimen boosted with ritonavir (CPI/r) in HIV infected patients that were previously exposed to antiretroviral therapy in the Netherlands.

Methods: We compared the projected lifetime costs and effects of two theoretical groups of 1000 patients, one receiving a standard of care regimen with TPV/r as a component and the other receiving a standard of care regimen with CPI/r. A 3-stage Markov model was formulated to represent three different consecutive HAART regimens. The model uses 12 health states based on viral load and CD4+ count to simulate disease progression. The transition probabilities for the Markov model were derived from a United States cohort of treatment experienced HIV patients. Furthermore, the study design was based on 48-week data from the RESIST-2 clinical trial and local Dutch costing data. Cost and health effects were discounted at 4% and 1.5% respectively according to the Dutch guideline. The analysis was conducted from the Dutch healthcare perspective using 2006 unit cost prices.

Results: Our model projects an accumulated discounted cost to the Dutch healthcare system per patient receiving the TPV/r regimen of euro167,200 compared to euro145,400 for the CPI/r regimen. This results in an incremental cost of euro21,800 per patient. The accumulated discounted effect is 7.43 life years or 6.31 quality adjusted life years (QALYs) per patient receiving TPV/r, compared to 6.91 life years or 5.80 QALYs per patient receiving CPI/r. This translates into an incremental effect of TPV/r over CPI/r of 0.52 life years gained (LYG) or 0.51 QALYs gained. The corresponding incremental cost effectiveness ratios (iCERs) are euro41,600 per LYG and euro42,500 per QALY.

Conclusion: We estimated the iCER for TPV/r compared to CPI/r at approximately euro40,000 in treatment experienced HIV-1 infected patients in the Netherlands. This ratio may well be in range of what is acceptable and warrants reimbursement for new drug treatments in the Netherlands, in particular in therapeutic areas as end-stage oncology and HIV and other last-resort health-care interventions.

No MeSH data available.


Related in: MedlinePlus