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Wamble D, Ciarametaro M, Houghton K, Ajmera M, Dubois RW. What’s Been The Bang For The Buck? Cost-Effectiveness Of Health Care Spending Across Selected Conditions In The US. Health Aff (Millwood) 2019; 38:68-75. [DOI: 10.1377/hlthaff.2018.05158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- David Wamble
- David Wamble is senior director of health economics at RTI Health Solutions in Durham, North Carolina
| | - Michael Ciarametaro
- Michael Ciarametaro is vice president of research at the National Pharmaceutical Council, in Washington, D.C
| | - Katherine Houghton
- Katherine Houghton is director of health economics at RTI Health Solutions in Durham
| | - Mayank Ajmera
- Mayank Ajmera is a senior research health economist at RTI Health Solutions in Research Triangle Park, North Carolina
| | - Robert W. Dubois
- Robert W. Dubois is chief science officer at the National Pharmaceutical Council
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Nelson RE, Ma J, Crook J, Knippenberg K, Nyman H, Paul D, Esker S, LaFleur J. Health Care Costs in a Cohort of HIV-Infected U.S. Veterans Receiving Regimens Containing Tenofovir Disoproxil Fumarate/Emtricitabine. J Manag Care Spec Pharm 2018; 24:1052-1066. [PMID: 30247099 PMCID: PMC10397780 DOI: 10.18553/jmcp.2018.24.10.1052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF), a key component in many human immunodeficiency virus (HIV) treatment regimens, is associated with increased renal and bone toxicities. The contributions of such toxicities to treatment costs, as well as the relative differences in treatment costs for various TDF/emtricitabine (FTC) regimens, remains unexplored. OBJECTIVE To estimate and compare mean overall and renal- and bone-specific costs, including total, inpatient, outpatient, and pharmacy costs in patients treated with TDF/FTC+efavirenz (EFV) compared with several non-EFV-containing TDF/FTC regimens. METHODS We conducted a national cohort study of treatment-naive HIV-infected U.S. veterans who initiated treatment from 2003 to 2015 with TDF/FTC in combination with EFV, elvitegravir/cobicistat, rilpivirine, or ritonavir-boosted protease inhibitors (atazanavir, darunavir, or lopinavir). Outcomes of interest were quarterly total, inpatient, outpatient, and pharmacy costs using data from the Veterans Health Administration (VHA) electronic medical record and Managerial Cost Accounting System (an activity-based accounting system that allocates VHA expenditures to patient encounters). We controlled for measured confounders using inverse probability of treatment (IPT) weights and assessed differences using standardized mean differences (SMDs). For comparisons where SMDs exceeded 0.1 after IPT weighting, we used the more conservative matching weights in sensitivity analyses. For hypothesis testing, we compared IPT-adjusted differences in quarterly costs between treatment groups using Mann-Whitney U-tests and generalized estimating equation (GEE) regression models. RESULTS Of 33,048 HIV-positive veterans, 7,222 met eligibility criteria, including 4,172 TDF/FTC + EFV recipients; mean (SD) age of the cohort was 50.0 (10.0) years; 96.7% were male; 60.1% were black; and 30.1% were white. Quarterly periods of exposure to EFV-containing regimens were 22,499 and of exposure to non-EFV-containing regimens were 11,633. After IPT weighting, absolute SMDs were < 0.1 except for a few covariates in the rilpivirine comparison. The per-patient adjusted mean total quarterly costs were $7,145 for EFV versus $8,726 for non-EFV (P < 0.001; Mann-Whitney U-test) and the per-patient adjusted mean difference in total quarterly costs was $1,419 lower for EFV versus all non-EFV combined (P < 0.001; GEE model). Corresponding values for outpatient costs ($2,656 vs. $2,942; P < 0.001; difference, -$254; P = 0.001), inpatient costs ($2,009 vs. $2,614; P < 0.001), radiology costs ($213 vs. $276; P < 0.001), and pharmacy costs ($2,480 vs. $3,170; P < 0.001; difference, -$600; P < 0.001) were all lower for EFV versus all non-EFV combined. Findings based on matching weights were qualitatively similar. Contributions of renal and bone costs to the total costs of treatment were very small, ranging between $52 and $94 per patient per quarter for renal outcomes and between $6 and $114 for bone outcomes. CONCLUSIONS Among 7,222 HIV-treated veterans over an average follow-up of 1.2 years per patient, those patients receiving TDF/FTC + EFV had lower overall health care costs compared with those receiving non-EFV regimens. DISCLOSURES This study was funded by Bristol-Myers Squibb. Nelson, Ma, Crook, Knippenberg, Nyman, and LaFleur are employees of the University of Utah, which received a grant from Bristol-Myers Squibb to conduct this study. Nyman also discloses honoraria for consulting from Otsuka and for writing a book chapter from Fresenius. La Fleur reports advisory board and consulting fees from Bristol-Myers Squibb outside of this study. Paul and Esker are employees of, and own stock in, Bristol-Myers Squibb.
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Affiliation(s)
- Richard E Nelson
- 1 Salt Lake City Health Care System, and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Junjie Ma
- 2 Salt Lake City Health Care System, and Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City
| | - Jacob Crook
- 1 Salt Lake City Health Care System, and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Kristin Knippenberg
- 2 Salt Lake City Health Care System, and Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City
| | - Heather Nyman
- 3 Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City
| | - Damemarie Paul
- 4 Research and Development, Bristol-Myers Squibb, Plainsboro, New Jersey
| | - Stephen Esker
- 4 Research and Development, Bristol-Myers Squibb, Plainsboro, New Jersey
| | - Joanne LaFleur
- 2 Salt Lake City Health Care System, and Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City
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Moltó J, Estévez JA, Miranda C, Cedeño S, Clotet B, Valle M. Population pharmacokinetic modelling of the changes in atazanavir plasma clearance caused by ritonavir plasma concentrations in HIV-1 infected patients. Br J Clin Pharmacol 2016; 82:1528-1538. [PMID: 27447851 PMCID: PMC5099552 DOI: 10.1111/bcp.13072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/27/2016] [Accepted: 07/17/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS The aim of the present study was to develop a simultaneous population pharmacokinetic model for atazanavir (ATV) incorporating the effect of ritonavir (RTV) on clearance to predict ATV concentrations under different dosing regimens in HIV-1-infected patients. METHODS A Cross-sectional study was carried out in 83 HIV-1-infected adults taking ATV 400 mg or ATV 300 mg/RTV 100 mg once daily. Demographic and clinical characteristics were registered and blood samples collected to measure drug concentrations. A population pharmacokinetic model was constructed using nonlinear mixed-effects modelling and used to simulate six dosing scenarios. RESULTS The selected one-compartmental model described the pharmacokinetics of RTV and ATV simultaneously, showing exponential, direct inhibition of ATV clearance according to the RTV plasma concentration, which explained 17.5% of the variability. A mean RTV plasma concentration of 0.63 mg l-1 predicted an 18% decrease in ATV clearance. The percentages of patients with an end-of-dose-interval concentration of ATV below or above the minimum and maximum target concentrations of 0.15 mg l-1 and 0.85 mg l-1 favoured the selection of the simulated ATV/RTV once-daily regimens (ATV 400 mg, ATV 300 mg/RTV 100 mg, ATV 300 mg/RTV 50 mg, ATV 200/RTV 100 mg) over the unboosted twice-daily regimens (ATV 300 mg, ATV 200 mg). CONCLUSIONS A one-compartment simultaneous model can describe the pharmacokinetics of RTV and ATV, including the effect of RTV plasma concentrations on ATV clearance. This model is promising for predicting individuals' ATV concentrations in clinical scenarios, and supports further clinical trials of once-daily doses of ATV 300 mg/RTV 50 mg or ATV 200 mg/RTV 100 mg to confirm efficacy and safety.
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Affiliation(s)
- José Moltó
- ‘Lluita contra la Sida’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
- Department de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Javier A. Estévez
- Pharmacokinetic/Pharmacodynamic Modeling and Simulation CIM‐St Pau.Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau‐IIB Sant PauBarcelonaSpain
- Departament de Farmacologia, de Terapèutica i de ToxicologiaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Cristina Miranda
- ‘Lluita contra la Sida’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
- Department de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Samandhy Cedeño
- ‘IrsiCaixa’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Bonaventura Clotet
- ‘Lluita contra la Sida’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
- Department de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain
- ‘IrsiCaixa’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Marta Valle
- Pharmacokinetic/Pharmacodynamic Modeling and Simulation CIM‐St Pau.Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau‐IIB Sant PauBarcelonaSpain
- Departament de Farmacologia, de Terapèutica i de ToxicologiaUniversitat Autònoma de BarcelonaBarcelonaSpain
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Wilkins E, Fisher M, Brogan AJ, Talbird SE, La EM. Cost-effectiveness analysis of tenofovir/emtricitabine and abacavir/lamivudine in combination with efavirenz or atazanavir/ritonavir for treatment-naïve adults with HIV-1 infection in the UK, based on the AIDS Clinical Trials Group 5202 clinical trial. HIV Med 2015; 17:505-15. [PMID: 26663715 DOI: 10.1111/hiv.12349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to assess the cost-effectiveness of the four regimens studied in the AIDS Clinical Trials Group (ACTG) 5202 clinical trial, tenofovir/emtricitabine (TDF/FTC) or abacavir/lamivudine (ABC/3TC) in combination with efavirenz (EFV) or atazanavir/ritonavir (ATV/r), for treatment-naïve adults with HIV-1 infection in the UK. METHODS A Markov model with six health states based on CD4 cell count ranges was developed to predict long-term costs and health outcomes for individuals on first-line therapy. Head-to-head efficacy data comparing TDF/FTC + EFV, TDF/FTC + ATV/r, ABC/3TC + EFV, and ABC/3TC + ATV/r were obtained from ACTG 5202 for up to 192 weeks. Antiretroviral drug costs were based on current list prices. Other medical costs (2013 UK pounds sterling), utility values, and mortality rates were obtained from published sources. Base-case, sensitivity, and subgroup analyses (by baseline viral load) were conducted. RESULTS Individuals using TDF/FTC-based regimens were predicted to remain on first-line therapy longer and accrue more quality-adjusted life-years (QALYs) than individuals using ABC/3TC-based regimens. At a willingness-to-pay threshold of £30 000 per QALY gained, TDF/FTC-based regimens were predicted to be cost-effective compared with ABC/3TC-based regimens, with incremental cost-effectiveness ratios of £23 355 for TDF/FTC + EFV vs. ABC/3TC + EFV and £23 785 for TDF/FTC + ATV/r vs. ABC/3TC + ATV/r. Results were generally robust in subgroup, sensitivity, and scenario analyses. CONCLUSIONS In an analysis of the regimens studied in ACTG 5202 for treatment-naïve adults with HIV-1 infection in the UK, TDF/FTC-based regimens yielded more favourable health outcomes and were generally predicted to be cost-effective compared with ABC/3TC-based regimens. These results confirm that TDF/FTC-based regimens are not only clinically effective but also cost-effective.
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Affiliation(s)
- E Wilkins
- North Manchester General Hospital, Manchester, UK
| | - M Fisher
- Brighton and Sussex Medical School, Brighton, UK
| | - A J Brogan
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - S E Talbird
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - E M La
- RTI Health Solutions, Research Triangle Park, NC, USA
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DuBois BN, Atrio J, Stanczyk FZ, Cherala G. Increased exposure of norethindrone in HIV+ women treated with ritonavir-boosted atazanavir therapy. Contraception 2014; 91:71-5. [PMID: 25245190 DOI: 10.1016/j.contraception.2014.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/04/2014] [Accepted: 08/16/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pharmacokinetics of norethindrone in combination oral contraceptive regimen are well described among HIV+ women treated with ritonavir-boosted protease inhibitor therapies; however, such characterization is lacking in women using progestin-only contraception. Our objective is to characterize pharmacokinetics of norethindrone in HIV+ women using ritonavir-boosted atazanavir treatment during progestin-only contraceptive regimens. STUDY DESIGN An open-label, prospective, nonrandomized trial to characterize the pharmacokinetics of norethindrone in HIV+ women receiving ritonavir-boosted atazanavir (n=10; treatment group) and other antiretroviral therapy known to not alter norethindrone levels (n=17; control group) was conducted. Following informed consent, women were instructed to take a single daily fixed oral dose of 0.35 mg norethindrone and 300 mg/100 mg atazanavir/ritonavir for 22 days. On day 22, serial blood samples were collected by venous catheter at 0, 1, 2, 3, 4, 6, 8, 12, 24, 48 and 72 h. Whole blood was processed to collect serum and stored at -20°C until later analysis using radioimmunoassay. Pharmacokinetic parameters were estimated using noncompartmental method. RESULTS In the treatment group, compared to the control group, an increase in area under the curve₀₋₂₄ (16.69 h*ng/mL vs. 25.20 h*ng/mL; p<.05) and maximum serum concentration (2.09 ng/mL vs. 3.19 ng/mL; p<.05), decrease (25%-40%) in apparent volume of distribution and apparent clearance, and unaltered half-life were observed. CONCLUSION(S) Our findings suggest that progestin-only contraceptives, unlike combination oral contraceptives, benefit from drug-drug interaction and achieve higher levels of exposure. Further studies are needed to establish whether pharmacokinetic interaction leads to favorable clinical outcomes. IMPLICATIONS Norethindrone-based progestin-only contraceptives, unlike combination oral contraceptives, exhibit greater drug exposure when co-administered with ritonavir-boosted atazanavir regimen and thus may not warrant a category 3 designation by the World Health Organization. Prospective studies are needed to confirm whether pharmacokinetic interaction results in favorable clinical outcomes.
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Affiliation(s)
- Barent N DuBois
- Oregon State University & Oregon Health Science University College of Pharmacy, Portland, OR, USA
| | - Jessica Atrio
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, New York, NY, USA
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Ganesh Cherala
- Oregon State University & Oregon Health Science University College of Pharmacy, Portland, OR, USA; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA.
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Cost-Effectiveness Studies in HIV Treatment with Lopinavir/Ritonavir: A Review. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2014. [DOI: 10.5301/grhta.5000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mauskopf J. A methodological review of models used to estimate the cost effectiveness of antiretroviral regimens for the treatment of HIV infection. PHARMACOECONOMICS 2013; 31:1031-1050. [PMID: 24234860 DOI: 10.1007/s40273-013-0098-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of this article was to perform a detailed methodological review of models used to estimate the cost effectiveness of drug treatment regimens for HIV infection in Europe and North America and assess the relationship between the different modeling approaches or key structural assumptions and the results. Electronic searches in three databases (MEDLINE, EMBASE, and the Cochrane Library) identified the cost-effectiveness models. Modeling approaches and structural assumptions were abstracted for all models. For three case studies of multiple analyses that compared the cost effectiveness of two drug regimens using the same clinical data inputs, differences in results were compared with differences in modeling approaches and structural assumptions. Forty-one model publications were reviewed. Recent models included Monte Carlo simulations, Markov models, or discrete-event simulation models, all including multiple lines of therapy and capturing the long-expected duration of efficacy of highly active antiretroviral therapy. In the three case studies, assumptions about the duration of efficacy after the trial time period, whether differences between the two regimens persist after the trial time period, the sequence of regimens after initial regimen failure, and the cost and utility assigned to adverse events, but not the modeling approach, were the most important factors in explaining differences in the results. As the models and treatment pathways get more complex, models should be validated using clinical trial data and local observational databases. The results of sensitivity analyses testing the impact of the structural assumptions that might change the results as identified in this review should also be presented in modeling papers.
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Foglia E, Bonfanti P, Rizzardini G, Bonizzoni E, Restelli U, Ricci E, Porazzi E, Scolari F, Croce D. Cost-utility analysis of lopinavir/ritonavir versus atazanavir + ritonavir administered as first-line therapy for the treatment of HIV infection in Italy: from randomised trial to real world. PLoS One 2013; 8:e57777. [PMID: 23460905 PMCID: PMC3584032 DOI: 10.1371/journal.pone.0057777] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 01/29/2013] [Indexed: 02/01/2023] Open
Abstract
Objective To estimate the lifetime cost utility of two antiretroviral regimens (once-daily atazanavir plus ritonavir [ATV+r] versus twice-daily lopinavir/ritonavir [LPV/r]) in Italian human immunodeficiency virus (HIV)-infected patients naïve to treatment. Design With this observational retrospective study we collected the clinical data of a cohort of HIV-infected patients receiving first-line treatment with LPV/r or ATV+r. Methodology A Markov microsimulation model including direct costs and health outcomes of first- and second-line highly active retroviral therapy was developed from a third-party (Italian National Healthcare Service) payer’s perspective. Health and monetary outcomes associated with the long-term use of ATV+r and LPV/r regimens were evaluated on the basis of eight health states, incidence of diarrhoea and hyperbilirubinemia, AIDS events, opportunistic infections, coronary heart disease events and, for the first time in an economic evaluation, chronic kidney disease (CKD) events. In order to account for possible deviations between real-life data and randomised controlled trial results, a second control arm (ATV+r 2) was created with differential transition probabilities taken from the literature. Results The average survival was 24.061 years for patients receiving LPV/r, 24.081 and 24.084 for those receiving ATV+r 1 and 2 respectively. The mean quality-adjusted life-years (QALYs) were higher for the patients receiving LPV/r than those receiving ATV+r (13.322 vs. 13.060 and 13.261 for ATV+r 1 and 2). The cost-utility values were 15,310.56 for LPV/r, 15,902.99 and 15,524.85 for ATV+r 1 and 2. Conclusions Using real-life data, the model produced significantly different results compared with other studies. With the innovative addition of an evaluation of CKD events, the model showed a cost-utility value advantage for twice-daily LPV/r over once-daily ATV+r, thus providing evidence for its continued use in the treatment of HIV.
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Affiliation(s)
- Emanuela Foglia
- CREMS (Centre for Research on Health Economics, Social and Health Care Management), University Carlo Cattaneo - LIUC, Castellanza, Varese, Italy
| | - Paolo Bonfanti
- Department of Infectious and Tropical Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Giuliano Rizzardini
- First and Second Departments of Infectious Diseases, L. Sacco Hospital Authority, Milan, Italy
| | - Erminio Bonizzoni
- Department of Occupational Health Clinica L. Devoto Labour, Section of Medical Statistics and Biometry G.A. Maccacaro, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Umberto Restelli
- CREMS (Centre for Research on Health Economics, Social and Health Care Management), University Carlo Cattaneo - LIUC, Castellanza, Varese, Italy
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Elena Ricci
- First and Second Departments of Infectious Diseases, L. Sacco Hospital Authority, Milan, Italy
| | - Emanuele Porazzi
- CREMS (Centre for Research on Health Economics, Social and Health Care Management), University Carlo Cattaneo - LIUC, Castellanza, Varese, Italy
| | - Francesca Scolari
- CREMS (Centre for Research on Health Economics, Social and Health Care Management), University Carlo Cattaneo - LIUC, Castellanza, Varese, Italy
| | - Davide Croce
- CREMS (Centre for Research on Health Economics, Social and Health Care Management), University Carlo Cattaneo - LIUC, Castellanza, Varese, Italy
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Roy U, McMillan J, Alnouti Y, Gautum N, Smith N, Balkundi S, Dash P, Gorantla S, Martinez-Skinner A, Meza J, Kanmogne G, Swindells S, Cohen SM, Mosley RL, Poluektova L, Gendelman HE. Pharmacodynamic and antiretroviral activities of combination nanoformulated antiretrovirals in HIV-1-infected human peripheral blood lymphocyte-reconstituted mice. J Infect Dis 2012; 206:1577-88. [PMID: 22811299 DOI: 10.1093/infdis/jis395] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lack of adherence, inaccessibility to viral reservoirs, long-term drug toxicities, and treatment failures are limitations of current antiretroviral therapy (ART). These limitations lead to increased viral loads, medicine resistance, immunocompromise, and comorbid conditions. To this end, we developed long-acting nanoformulated ART (nanoART) through modifications of existing atazanavir, ritonavir, and efavirenz suspensions in order to establish cell and tissue drug depots to achieve sustained antiretroviral responses. NanoART's abilities to affect immune and antiviral responses, before or following human immunodeficiency virus type 1 infection were tested in nonobese severe combined immune-deficient mice reconstituted with human peripheral blood lymphocytes. Weekly subcutaneous injections of drug nanoformulations at doses from 80 mg/kg to 250 mg/kg, 1 day before and/or 1 and 7 days after viral exposure, elicited drug levels that paralleled the human median effective concentration, and with limited toxicities. NanoART treatment attenuated viral replication and preserved CD4(+) Tcell numbers beyond that seen with orally administered native drugs. These investigations bring us one step closer toward using long-acting antiretrovirals in humans.
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Affiliation(s)
- Upal Roy
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
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Simpson KN, Baran RW, Collomb D, Beck EJ, Van de Steen O, Dietz B. Economic and health-related quality-of-life (HRQoL) comparison of lopinavir/ritonavir (LPV/r) and atazanavir plus ritonavir (ATV+RTV) based regimens for antiretroviral therapy (ART)-naïve and -experienced United Kingdom patients in 2011. J Med Econ 2012; 15:796-806. [PMID: 22563716 DOI: 10.3111/13696998.2012.691927] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Using a United Kingdom (UK)-based National Health Services perspective for 2011 this study first estimated the cost-effectiveness and budget impact implications for lopinavir/ritonavir (LPV/r) vs atazanavir plus ritonavir (ATV+RTV) treatment of antiretroviral therapy (ART)-naïve patients and secondly examined the long-term health-related quality-of-life (HRQoL) and economic implications for LPV/r vs ATV+RTV treatment of ART-experienced patients. METHODS A previously published Markov model that integrates epidemiological data of human immunodeficiency virus (HIV) with predictors of coronary heart disease (CHD) was modified under a clearly specified set of assumptions to reflect viral load (VL) suppression profiles and other differences for these two regimens, applying results from the CASTLE study in ART-naïve patients and using data from BMS-045 in ART-experienced patients. ART costs were referenced to current (2011) pricing guidelines in the UK. Medical care costs reflected UK treatment patterns and relevant drug pricing. Costs and outcomes were discounted at 3.5% per year. Costs are expressed in British pounds (£) and life expectancy in quality-adjusted life years (QALYs). RESULTS In the ART-naïve subjects, the model predicted a marginal improved life expectancy of 0.031 QALYs (11 days) for the ATV+RTV regimen as a result of predicted CHD outcomes based on lower increases in cholesterol levels compared with the LPV/r regimen. The model demonstrated cost savings with the LPV/r regimen. The total lifetime cost savings was £4070 per patient for the LPV/r regimen. LPV/r saved £2133 and £3409 per patient at 5 and 10 years, respectively. Referenced to LPV/r, the incremental cost-effectiveness ratio (ICER) for ATV+RTV was £149,270/QALY. For ART-experienced patients VL suppression differences favored LPV/r, while CHD risk associated with elevated total cholesterol marginally favored ATV+RTV, resulting in a net improvement in life expectancy of 0.31 QALYs (106 days) for LPV/r. Five-year costs were £5538 per patient greater for ATV+RTV, with a discounted lifetime saving of £1445 per LPV/r patient. LPV/r was modestly dominant economically, producing better outcomes and cost savings. LIMITATIONS The limitations of this study include uncertainty related to how well the model's assumptions capture current practice, as well as the validity of the model parameters used. This study was limited to using aggregated data in the public domain from the two clinical trials. Thus, some of the model parameters may reflect limitations due to trial design and data aggregation bias. This study has attempted to illuminate the effect of these limitations by presenting the results of the comprehensive sensitivity analysis. CONCLUSIONS Based on 2011 costs of HIV in the UK and the published efficacy data from the CASTLE and BMS-045 studies, ATV+RTV-based regimens are not expected to be a cost-effective use of resources for ART-naïve patients similar to patients in the CASTLE study, nor for ART-experienced patients based on the only published comparison of ATV+RTV and LPV/r.
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Affiliation(s)
- K N Simpson
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, SC 29425, USA.
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