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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Belete, Yared

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Addis Abeba University


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.



Cost-utility, dolutegravir, efavirenz, EQ-5D, HIV/AIDS, ICER, utility