PHARMACOECONOMIC ANALYSIS OF FIRS-LINE ANTIRETROVIRAL THERAPY
Objectives. The cost effectiveness of first-line antiretroviral therapy (ART) was evaluated. Materials and methods. Retrospective analysis of the results of treatment of 260 HIV patients who received ART for 5 years at Saint-Petersburg AIDS Center. Modelling was carried out for the three most commonly prescribed first-line regimens: nucleoside reverse transcriptase inhibitors+protease inhibitors (NRTI+PI), namely Zidovudine/Lamivudine+Lopinavir/Ritonavir (3TC/AZT+LPV/r), and NRTI+non-nucleoside reverse transcriptase inhibitor (NNRTI), namely Zidovudine/Lamivudine+Efavirenz (3TC\AZT+EFV) and Zidovudine/Lamivudine+Nevirapine (3TC\AZT+NVP). Direct medical costs estimates included expenses for HIV treatment according to the main regimens and for alternative therapies in case the main ones fail, for correction of adverse effects and for laboratory diagnostics, in-patient accomodation, and examinations and follow-up by medical personnel. Results and discussion. Direct therapeutic costs increased in the resent 5 years by 14% on average and by 69% for 3TC/AZT+LPV/r and by 61% for 3TC/AZT+EFV and 3TC/AZT+NVP because of more frequent replacement of NNRTI with more costly second-line drugs or alternative regimens necessitated by adverse by-effects and their treatment. Cost/effectiveness ratio (CER), that is expenses per one patient treated for five years, was the lowest for 3TC/AZT+EFV at 200-1 and for 3TC/AZT+NVP at CD4-1. The 3TC/AZT+EFV regimen recommended as the main one for the onset of HIV treatment at 200-1 provides for a decrease in budget load compared with that associated with the regimens that include IP and is preferable in the pharmacoeconomic sense. However, higher rates of by-effects and complications cause turning to more costly drugs in shorter times. The first-line HAART regimen including IP (Lopinavir/Ritonavir), although it is more costly, is characterised by a similar CER for patients having 200-1 at baseline. In patients having CD4-1, the IP-containing regimen 3TC/AZT+LPV/r is more efficient clinically and allows to keep more patients being treated with HAART; however, CER is lower in this case compared with NNRTI regimens.