Cost-Effectiveness of Dolutegravir- Versus Efavirenz-Based First-Line Antiretroviral Treatments and Health-related Quality of Life of Adults with HIV/AIDS in Ethiopia
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Date
2019-12
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Addis Abeba University
Abstract
Background: In Ethiopia, the dolutegravir (DTG)-based regimen is as of now favored
over the efavirenz (EFV)-based regimen in the treatment of patients with human
immunodeficiency virus (HIV)/acquired immune-deficiency syndrome (AIDS).
Objective: To determine the cost-effectiveness of DTG- versus EFV-based first-line
treatment and health-related quality of life among Ethiopian adults with HIV/AIDS.
Methods: Cost-utility analysis was done using a microsimulation model. The health-
related utility value was obtained from adult HIV/AIDS patients receiving antiretroviral
treatment at Tikur Anbessa Specialized Hospital. Mann-Whitney U and Kruskal-Wallis
tests were done to compare utility values based on patient characteristics. Incremental
cost-effectiveness ratio (ICER) was used to determine cost-effectiveness of the
proposed regimens and deterministic sensitivity analysis was conducted to assess the
parameter uncertainty in cost utility analysis.
Results: Median utility values of HIV/AIDS patients were 0.94 (interquartile range
(IQR) =0.87, 1) and 80% (IQR= 70%, 90%) on the EuroQol-5 dimensions (EQ-5D)
index and EuroQol-visual analog scales (EQ-VAS) score respectively. Comorbidity,
cluster of differentiation 4 and number of medicines were significantly associated with
EQ-5D and EQ-VAS values with, p <0.001. Compared to EFV-based regimen, the
DTG-based regimen was associated with an expected lifetime cost of 12,709 United
States dollar ($) (versus $12,701) and expected quality adjusted life month (QALM)
gains of 183 (versus176 QALMs) resulting ICER value of $1.14 per QALM.
Conclusion: Overall utility value of HIV/AIDS patient is reported as lower than the
general population. Replacing EFV- with DTG-based first-line regimen for HIV/AIDS
patients in Ethiopian setting was found to be cost-effective.
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Keywords
Cost-utility, dolutegravir, efavirenz, EQ-5D, HIV/AIDS, ICER, utility