Cost-Effectiveness of Juluca (dolutegravir/rilpivirine) for Human Immunodeficiency Virus (HIV-1) Infection Treatment in Virologically Suppressed Adults in Taiwan

Objectives: Although the efficacy of traditional 3-drug regimens for the treatment of HIV is well established, tolerability and toxicity concerns remain. New 2-drug regimens such as Juluca (dolutegravir [DTG]/rilpivirine [RPV]) offer noninferior efficacy versus 3-drug regimens (SWORD-1 and SWORD-2 s...

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Bibliographic Details
Main Authors: Anderson, S.-J (Author), Hsu, C.-Y (Author), Ko, N.-Y (Author), Lopes, S. (Author), Ou, H.-T (Author), Yang, C.-T (Author)
Format: Article
Language:English
Published: Elsevier Inc. 2021
Subjects:
HIV
Online Access:View Fulltext in Publisher
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Summary:Objectives: Although the efficacy of traditional 3-drug regimens for the treatment of HIV is well established, tolerability and toxicity concerns remain. New 2-drug regimens such as Juluca (dolutegravir [DTG]/rilpivirine [RPV]) offer noninferior efficacy versus 3-drug regimens (SWORD-1 and SWORD-2 studies), while reducing cumulative drug exposure and potentially long-term toxicities and drug-drug interactions. Here, we assess the cost-effectiveness of DTG/RPV for the treatment of HIV-1 for virologically suppressed adults in Taiwan. Methods: A hybrid decision tree and Markov cohort state transition model was used to evaluate the expected economic costs and clinical outcomes associated with DTG/RPV and comparators. Model health states were defined by viral load and CD4 cell count. Efficacy and safety data were informed from SWORD-1 and SWORD-2 studies and the literature. The risk of long-term toxicities (cardiovascular disease, bone fractures, and chronic kidney disease) were included. Current branded drug acquisition prices were included, and healthcare costs informed by a bespoke costing study using National Health Insurance Research Database data. Incremental cost-effectiveness ratios were calculated and compared with a willingness-to-pay threshold of 2 times Taiwan's gross domestic product (NT
ISBN:22121099 (ISSN)
DOI:10.1016/j.vhri.2020.11.010