Cost-Effectiveness Studies in HIV Treatment with Lopinavir/Ritonavir: A Review

Sostenibilità economica ed implicazioni di policy nell'implementazione di nuove strategie per la gestione dell'HIV. Una lettura critica basata sulle evidenze di costo-efficacia del regime terapeutico lopinavir/ritonavir

Abstract

In the last 20 years the spread of antiretroviral drugs has significantly improved the life expectancy of people with HIV. Nevertheless, antiretroviral therapy comes with an increase in expenditure and prescription because often the combination of two or more active ingredients is used. Recent studies have shown that ritonavir-boosted protease inhibitors – the class of antiviral drugs lopinavir/ritonavir belong to – show the same effectiveness as the combination of antiretroviral therapy (cART) and reduce both the cost of treatment and the occurrence of the side effects associated with long-term exposure to combinations of drugs. In this paper we conducted a systematic review of the evidence about the cost-effectiveness of lopinavir/ritonavir (LPV/r). In particular, we used as search engine: PubMed and Dare. In PubMed search, we used the following key words: HIV, Kaletra, lopinavir/ritonavir, cost effectiveness, cost minimization, cost utility, cost of illness, cost benefit, economic evaluation, economic assessment, economic analysis. In the DARE database we used as keywords: lopinavir/ritonavir and Kaletra. The PubMed search yielded 299 articles, while Dare yielded ten. In this study 12 articles were included: nine cost-utility analyses, one cost-effectiveness analysis, one cost-of-illness analysis and one cost-minimization analysis. The review has shown that in most of the recent studies, LPV/r was found to be cost-effective in several therapeutic regimens. Therefore this therapeutic strategy demonstrates a potentially advantageous profile that could enable an efficient use of health care resources.