Budget impact analysis in the maintenance raltegravir-containing regimen in virologically suppressed HIV infected patients

Impatto Economico Dei Regimi Semplificati a Base di Raltegravir Nel Trattamento di Mantenimento Dei Pazienti HIV-1 Infetti in Soppressione Virologica

Abstract

Background A one-year cost analysis was conducted to estimate the impact from the perspective of the Italian National Health Service (NHS) of nevirapine or etravirine or rilpivirine plus raltegravir administration as maintenance antiretroviral therapy in virologically suppressed HIV-1 infected patients. Methods Patient data were retrieved from the electronic medical record system in use (year 2016) in a reference HIV centre in South Italy. The analysis considered patients with long-term (more than 1 year) virological suppression (HIV-1 RNA <50 copies/mL) on Highly Active Antiretroviral Therapy (HAART) and no prior exposure to integrase inhibitors (INIs). To estimate the total HAART expenditure, we calculated the annual treatment cost for each enrolled patient. Subsequently, to estimate the dual therapy hypothetical expenditure, we assumed to treat the same patients with nevirapine or rilpivirine or etravirine and raltegravir. We took into account only drug costs (ex-factory prices, included all discounts and VAT) from the perspective of the Italian NHS. Results In 2016, the total expenditure for the 116 enrolled HIV-1 infected patients treated with HAART was €869,889. The mean treatment cost per patient was €7,499. If all patients were treated with the dual therapy (nevirapine/raltegravir), the total expenditure would be €641,016 (-26.3%) with a mean treatment cost per patient of €5,526 and a potential total saving of €228,873. On the contrary, the dual regimen based on etravirine or rilpivirine associated with raltegravir would engender respectively a 35.5% and 8.7% expenditure increase. Conclusions From the Italian NHS perspective, nevirapine/raltegravir represent a cost-saving option as maintenance antiretroviral therapy in virologically suppressed HIV-1 infected patients.