Aims: To conduct a cost-efficacy analysis of lopinavir/ritonavir (LPV/r) monotherapy as a maintenance regimen following induction of virological response with triple therapy including LPV/r. The pharmacoeconomic analysis was performed from the perspective of the Spanish public health system.
Methods: A cost-efficacy analysis was performed in a phase IV-II, comparative, randomized, multicenter, open-label clinical trial evaluating the efficacy and safety of maintenance therapy with LPV/r monotherapy versus continuation of triple therapy in HIV-infected patients with a persistently undetectable viral load for 6 months. For the pharmacoeconomic analysis, efficacy was defined as the proportion of patients with plasma HIV RNA concentrations < 50 copies/mL at 48 weeks from the start of the study. An intent-to-treat analysis was performed. Only direct costs were considered. Cost, efficacy and the cost-efficacy ratio were calculated for each treatment option.
Results: The cost-efficacy ratio of LPV/r maintenance monotherapy was 5186 euros per unit of achieved effect (patient with plasma HIV RNA concentrations < 50 copies/mL at 48 weeks), whereas maintenance with triple therapy had a cost-efficacy ratio of 8688 euros per unit of achieved effect.
Conclusion: The option of LPV/r monotherapy as maintenance therapy in HIV-infected patients following induction of virological response with triple therapy including LPV/r might be a more efficient alternative than maintaining triple therapy, as evidenced by a more favorable cost-efficacy ratio.