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Titolo:
Efavirenz - A pharmacoeconomic review of its use in HIV infection
Autore:
Plosker, GL; Perry, CM; Goa, KL;
Indirizzi:
Adis Int Ltd, Auckland 10, New Zealand Adis Int Ltd Auckland New Zealand10 s Int Ltd, Auckland 10, New Zealand
Titolo Testata:
PHARMACOECONOMICS
fascicolo: 4, volume: 19, anno: 2001,
pagine: 421 - 440
SICI:
1170-7690(2001)19:4<421:E-APRO>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
HUMAN-IMMUNODEFICIENCY-VIRUS; ACTIVE ANTIRETROVIRAL THERAPY; COST-EFFECTIVENESS; PROTEASE INHIBITORS; COMBINATION THERAPY; NUCLEOSIDE ANALOGS; CUBIC MILLIMETER; ECONOMIC-IMPACT; PLUS INDINAVIR; CELL COUNTS;
Keywords:
HIV infection; AIDS; pharmacoeconomics; cost effectiveness; therapeutic use; tolerability; quality of life;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
80
Recensione:
Indirizzi per estratti:
Indirizzo: Plosker, GL Adis Int Ltd, 41 Centorian Dr,Private Bag 65901, Auckland 10, New Zealand Adis Int Ltd 41 Centorian Dr,Private Bag 65901 Auckland New Zealand 10
Citazione:
G.L. Plosker et al., "Efavirenz - A pharmacoeconomic review of its use in HIV infection", PHARMACOECO, 19(4), 2001, pp. 421-440

Abstract

Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI) usedin the treatment of patients with HIV infection. Both US and British treatment guidelines for HIV infection recommend NNRTI- or protease inhibitor-based combinations [i.e. with nucleoside reverse transcriptase inhibitors (NRTIs)] as first-line treatment options in the management of HIV disease. Results of a pivotal randomised study (DMP 266-006) comparing efavirenz-versusindinavir-based triple combination therapy in patients with HIV infection (the majority of whom were antiretroviral therapy-naive) showed the efavirenz-based regimen was better tolerated and had greater success in achieving reductions in viral load below the limit of detection. These and other clinical data were incorporated into economic models in 2 analyses, one conducted in the US and the other in Canada. The US analysis examined long term clinical and economic outcomes predicted on the basis ofresponse (viral load and CD4+ cell counts), tolerability and willingness to adhere to therapy. The efavirenz-based regimen was the dominant treatmentstrategy as it was predicted to improve survival and reduce direct medicalcosts in the US healthcare system. Compared with the indinavir-containing regimen, survival was increased by 11% (absolute difference) and cumulativecosts were reduced by $US 10 326 per patient (1998 discounted costs) at 5 years after starting treatment with efavirenz-based therapy. The Canadian analysis was conducted from the perspective of the Ontario healthcare system. This study did not consider differences in clinical efficacy between treatment groups, costs of study medication or outcomes beyond 1 year - all factors that would have favoured the efavirenz-based regimen. Of the 2 treatment options, the efavirenz-based regimen was associated with 7.4% lower average annual medical care costs, primarily because of greater costs associated with adverse clinical events with the indinavir-based regimen. In conclusion, current treatment guidelines for HIV infection recognise efavirenz-based combination regimens as a first-line treatment option. A pivotal comparative clinical trial (DMP 266-006) showed a significantly greatervirological response to efavirenz- than indinavir-based triple combinationtherapy, and the efavirenz-based regimen was better tolerated. These clinical data are supported by pharmacoeconomic analyses conducted in the US andCanada, both of which showed lower medical care costs with the efavirenz-based regimen. The US analysis also predicted long term health benefits, such as improved survival, with efavirenz- versus indinavir-based triple combination therapy. These results must be weighed against the inherent difficulties of predicting long term treatment failure rates from short term data, and the limited number of pharmacoeconomic analyses conducted with efavirenz to date.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/04/20 alle ore 06:34:45