International Journal of STD & AIDS > Volume 19, Number 5 > Pp. 297-304

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Original research articles

Treatment outcome and cost-effectiveness of different highly active antiretroviral therapy regimens in the UK (1996–2002)

E J Beck ^*  , S Mandalia ^* , M Youle ^* , R Brettle ^¶, M Fisher ^#, M Gompels ^||, G Kinghorn ^**, B McCarron , A Pozniak , A Tang , J Walsh ^¶¶, I Williams ^## and B Gazzard ^* 

^* NPMS–HHC Coordinating and Analytic Centre; London School of Hygiene & Tropical Medicine; Imperial College; Royal Free Hospital, London; ^¶ Edinburgh General Hospital, Edinburgh; ^# Royal County Sussex Hospital, Brighton; ^|| Southmead Hospital, Bristol; ^** Royal Hallamshire Hospital, Sheffield; James Cook University Hospital, Middlesborough; Chelsea and Westminster Hospital, London; Royal Berkshire Hospital, Berkshire; ^¶¶ St Mary's Hospital; ^## Mortimer Market Centre, London, UK

Correspondence to: Dr E J Beck, Evidence, Policy and Monitoring Division (EMP), UNAIDS, 20 Avenue Appia, 1211 Geneva 27, Switzerland Email: becke{at}unaids.org; eduard_beck{at}bluewin.ch

The aim of this study was to estimate the outcome and cost-effectiveness per life-year-gained (LYG) of first-, second- and third-line non-nucleoside reverse transcriptase inhibitors (NNRTI) versus protease inhibitor (PI) containing highly active antiretroviral therapy regimens. Hospital care costs (2002 US dollars discounted 3.5% per annum) were linked to treatment failure times. Results show that the median time-to-treatment failure for first-line (nucleoside reverse transcriptase inhibitors) 2NRTIs + NNRTI was substantially longer than that for 2NRTIs + PI_boosted, 2NRTIs + PI and 2NRTIs + 2PIs, whereas for second- and third-line they were similar. Comparing first-line 2NRTIs + NNRTI with 2NRTIs + PI_boosted cost per LYG was US$ 12,375; US$ 12,139 per LYG when compared with 2NRTIs + PI and US$ 2948 per LYG when compared with 2NRTIs + 2PIs. For second-line cost per LYG comparing 2NRTIs + NNRTI with 2NRTIs + PI_boosted was US$ 19,501; US$ 18,364 per LYG when compared with 2NRTIs + PI and cost-saving when compared with 2NRTIs + 2PIs. For third-line cost per LYG comparing 2NRTIs + NNRTI with 2NRTIs + PI_boosted was US$ 2708; US$ 11,559 per LYG when compared with 2NRTIs + PI and cost-saving when compared with 2NRTIs + 2PIs. In conclusion, first-line 2NRTIs + NNRTI was cost-effective or cost-saving when compared with PI-containing regimens for all lines of therapy. Such information is required by clinicians and managers of HIV services to make appropriate treatment decisions based on clinical and financial grounds, and given the increasing number of people living with HIV, such information will become more important over time.

Key Words: HIV • first- • second- • third-line HAART regimens • outcomes • cost-effectiveness

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