screening cohort. Costs and population mortality data were specific to ..... modeled rate of CD4+ cell recovery to 48 weeks was treatment- specific and based on ...
Volume 13 • Number 8 • 2010 VA L U E I N H E A LT H
Cost-Effectiveness of Maraviroc for Antiretroviral Treatment-Experienced HIV-infected Individuals in Mexico
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Iris Contreras-Hernandez, MD, MSc,1 Debbie Becker, MSc,2 Jeremy Chancellor, MSc,3 Felicitas Kühne, MSc,4 Joaquin Mould-Quevedo, PhD, MSc, MBA,5 Gabriela Vega, MSc,6 Shalaka Marfatia, BPharm, MS, MPH7 1
Health Economics Research Unit, Social Security Mexican Institute, Mexico City, Mexico; 2Health Economics and Outcomes Research, i3 Innovus, Burlington, ON, Canada; 3Health Economics and Outcomes Research, i3 Innovus, Uxbridge, United Kingdom (at the time of the conduct of this study); 4Health Economics and Outcomes Research, i3 Innovus; PharmacoConsult, Uxbridge, United Kingdom; 5Pfizer Mexico, Mexico City, Mexico; 6Pfizer Mexico, Mexico City, Mexico (at the time of the conduct of this study); 7Pfizer Inc., New York, NY, USA (at the time of the conduct of this study)
A B S T R AC T Objective: Maraviroc is the first approved drug in a new class of antiretrovirals, the CCR5 antagonists. The objective of this study was to predict the long-term clinical impact and cost-effectiveness of maraviroc in treatment-experienced adults with HIV/AIDS in Mexico. Methods: The AntiRetroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model was adapted to the Mexican context to predict clinical and economic outcomes of treating with optimized background therapy (OBT) versus testing for viral tropism status and treating with OBT ⫾ maraviroc accordingly in treatment-experienced adults in Mexico. Baseline characteristics and efficacy were from the MOTIVATE trials’ screening cohort. Costs and population mortality data were specific to Mexico. Results were reported from the perspective of health care payers in 2008 Mexican pesos (converted to 2008 US$ in parentheses). Results: Compared to treatment with OBT alone, treatment with OBT ⫾ maraviroc contingent on tropism test result increased projected
undiscounted life expectancy and discounted quality-adjusted life expectancy from 7.54 to 8.71 years and 4.42 to 4.92 quality-adjusted life years (QALYs), respectively, at an incremental cost of $228,215 (US$21,329). The resultant incremental cost-effectiveness ratio (ICER) was $453,978 (US$42,429) per QALY gained. The ICER was somewhat lower when maraviroc was modeled in individuals susceptible to ⱕ2 components of OBT ($407,329; US$38,069), while the ICER was higher in individuals susceptible to ⱖ3 OBT components ($718,718; US$67,171). Conclusion: In treatment-experienced individuals with HIV/AIDS in Mexico, maraviroc may be cost-effective, particularly in individuals with limited options for active antiretroviral therapy (ART). Keywords: AIDS, anti-HIV agents, cost-effectiveness, economic model, HIV, maraviroc, Mexico.
Introduction
strains after long exposure to ART therapies, resulting in treatment failure. The newly developed drug maraviroc is the first of a class known as CCR5 antagonists. Maraviroc selectively and reversibly binds to CCR5 receptor on CD4+ cells, preventing interaction with the gp120 protein of CCR5-tropic virions and subsequent entry. In double-blind, placebo-controlled clinical trials, maraviroc in addition to optimized background therapy (OBT) were compared to OBT alone in treatment-experienced adults infected with CCR5-tropic HIV-1 [7]. Patients treated with maraviroc achieved a substantially greater viral load reduction than did patients treated with OBT alone (-1.84 and -0.78 log10 copies/mL, respectively), with over twice the proportion of patients achieving undetectable levels of HIV-1 (56.1% and 22.5% with 500, 351–500, 201–350, 101–200, 51–100, and
