Lee TA, Sullivan SD, Veenstra DL, Ramsey SD, Steger PJ, Malinverni R, Pleil AM, Williamson T. Economic evaluation of systemic treatments for cytomegalovirus retinitis in patients with AIDS.
PHARMACOECONOMICS 2001;
19:535-550. [PMID:
11465299 DOI:
10.2165/00019053-200119050-00008]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE
To determine the cost of using systemic therapy to treat newly diagnosed cytomegalovirus (CMV) retinitis in persons with AIDS.
DESIGN
Incidence-based simulation model of CMV treatment from a government payer perspective.
SETTING
Swiss healthcare system.
PATIENTS AND PARTICIPANTS
Patients with AIDS and newly diagnosed CMV retinitis.
INTERVENTIONS
Patients were assigned to 1 of 4 treatment regimens for induction and maintenance therapy: (i) intravenous (IV) cidofovir induction and maintenance (cidofovir IV/IV); (ii) IV foscarnet induction and maintenance (foscarnet IV/IV); (iii) IV ganciclovir induction and maintenance (ganciclovir IV/IV); and (iv) IV ganciclovir induction and oral (PO) ganciclovir maintenance (ganciclovir IV/PO). Following a second relapse, patients were assigned to one of the other regimens.
MAIN OUTCOME MEASURES
Time to first and subsequent progression, duration of maintenance treatment and direct medical expenditures [1998 Swiss francs (SwF)] .
RESULTS
The median time to first progression was longest for cidofovir IV/IV, followed by foscarnet IV/IV, ganciclovir IV/IV and ganciclovir IV/PO. Mean survival was 13 months and mean costs for this period in the base case were lowest in those initially treated with cidofovir (SwF146,742), followed by initial treatment with foscarnet IV/IV (SwF194,809), ganciclovir IV/PO (SwF195,190) and ganciclovir IV/IV (SwF243,964). Costs were most sensitive to changes in efficacy estimates.
CONCLUSIONS
Of the regimens studied, initiation of treatment with systemic cidofovir appears least costly over a 13-month period.
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