Cost-Efficacy Analysis of the MONET Trial Using UK Antiretroviral Drug Prices

Authors: Gazzard, Brian¹; Hill, Andrew²; Anceau, Anne³

Source: Applied Health Economics and Health Policy, Volume 9, Number 4, 1 July 2011 , pp. 217-223(7)

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Abstract:

Background In virologically suppressed patients, switching to darunavir/ritonavir (DRV/r) monotherapy maintains HIV RNA suppression, and could also lower treatment costs.

Objective The purpose of this analysis was to calculate the potential cost savings from the use of DRV/r monotherapy in the UK.

Methods In the MONET trial, 256 patients with HIV RNA <50 copies/mL on current highly active antiretroviral therapy (HAART) for over 24 weeks (non-nucleoside reverse-transcriptase inhibitor [NNRTI] based [43%] or protease inhibitor [PI] based [57%]), switched to DRV/r 800/100 mg once daily, either as monotherapy (n = 127) or with two NRTIs (n = 129). The UK costs per patient with HIV RNA <50 copies/mL at week 48 (responders) were calculated using a `switch included' analysis to account for additional antiretrovirals taken after initial treatment failure. By this analysis, efficacy was 93.5% versus 95.1% in the DRV/r monotherapy and triple therapy arms, respectively. British National Formulary 2009 values were used.

Results Before the trial, the mean annual cost of antiretrovirals was £6906 for patients receiving NNRTI-based HAART, and £8348 for patients receiving PI-based HAART. During the MONET trial, the mean annual per-patient cost of antiretrovirals was £8642 in the triple therapy arm, of which 55% was from NRTIs and 45% from PIs. The mean per-patient cost in the monotherapy arm was £4126, a saving of 52% versus triple therapy. The mean cost per responder was £9085 in the triple therapy arm versus £4413 in the DRV/r monotherapy arm.

Conclusions Based on the MONET results, the lower cost of DRV/r monotherapy versus triple therapy in the UK would allow more patients to be treated for fixed budgets, while maintaining HIV RNA suppression at <50 copies/mL. If all patients meeting the inclusion criteria of the MONET trial in the UK were switched to DRV/r monotherapy, there is the potential to save up to £60 million in antiretroviral drug costs from the UK NHS budget.

Keywords: Budget-impact-analysis; Cost-effectiveness; Darunavir/ritonavir; HIV-infection

Document Type: Short communication

Affiliations: 1: 1 Chelsea and Westminster Hospital, London, UK 2: 2 Pharmacology Research Laboratories, University of Liverpool, Liverpool, UK 3: 3 Janssen-Cilag, Issy-les-Moulineaux, France

Publication date: 2011-07-01

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Cost-Efficacy Analysis of the MONET Trial Using UK Antiretroviral Drug Prices

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