Cost-Effectiveness of the Third-Agent Class in Treatment-Naive Human Immunodeficiency Virus-Infected Patients in Portugal 英文参考文献.docVIP

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Cost-Effectiveness of the Third-Agent Class in Treatment-Naive Human Immunodeficiency Virus-Infected Patients in Portugal 英文参考文献.doc

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Cost-Effectiveness of the Third-Agent Class in Treatment-Naive Human Immunodeficiency Virus-Infected Patients in Portugal 英文参考文献

Cost-EffectivenessoftheThird-AgentClassinTreatment- NaiveHumanImmunodeficiencyVirus-InfectedPatients inPortugal FilipaAraga?o1,2*,Jose′ Vera3,Ine?sVazPinto3 1Escola Nacional de Sau′de Pu′blica, Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal, 2Associac?a?o SER+, Rua Andre′ Homem, Cascais, Cascais, Portugal, 3HPP - HospitaldeCascais,Alcabideche,Cascais,Portugal Abstract Introduction: Current Portuguese HIV treatment guidelines recommend initiating antiretroviral therapy with a regimen composed of two Nucleoside Reverse Transcriptase Inhibitors plus one Non-nucleoside Reverse Transcriptase Inhibitor (2NRTI+NNRTI)ortwoNucleosideReverseTranscriptaseInhibitorsplusoneboostedproteaseinhibitor(2NRTI+PI/r).Given thelowerdailycostofNNRTIasthethirdagentwhencomparedtotheaveragedailycostsofPI/r,itisrelevanttoestimate thelongtermimpactofeachtreatmentoptioninthePortuguesecontext. Methods: We developed a microsimulation discrete events model for cost-effectiveness analysis of HIV treatment, simulating individual paths from ART initiation to death. Four driving forces determine the course of events: CD4+ cell count,viralload,resistanceandadherence.Distributionsoftimetoeventareconditionaltoindividuals’characteristicsand past history. Time to event was modeled using parametric survival analysis using Stata 11H. Disease progression was structured according to therapy lines and the model was parameterized with cohort Portuguese observational data. All resourceswerevaluedat2009prices.TheNationalHealthService’sperspectivewasassumedconsideringalifetimehorizon anda5%annualdiscountrate. Results: Inthisanalysis,initiatingtherapywithtwoNucleosideReverseTranscriptaseInhibitors plusoneNon-nucleoside ReverseTranscriptaseInhibitorreducestheaveragenumberofswitchesby17%,saves19.573Jperindividualandincreases life expectancy by 1.7 months showing to be a dominant strategy in 57% of the simulations when compared to two NucleosideReverseTranscriptaseInhibitorsplusoneboostedproteaseinhibitor