logo
Science Portal
Copyright © Médecins Sans Frontières
v2.1.5209.produseast1
About MSF Science Portal
About
Contact Us
Frequently Asked Questions (FAQs)
Privacy Policy
Terms of Use
Copyright © Médecins Sans Frontières
v2.1.5209.produseast1
Cost and cost-effectiveness of switching from d4T or AZT to a TDF-based first-line regimen in a resource-limited setting in rural Lesotho | Journal Article / Research | MSF Science Portal
Journal Article
|Research

Cost and cost-effectiveness of switching from d4T or AZT to a TDF-based first-line regimen in a resource-limited setting in rural Lesotho

Jouquet G, Bygrave H, Kranzer K, Ford NP, Gadot L, Lee JS, Hilderbrand K, Goemaere E, Vlahakis N, Trivino L, Makakole L, Cleary S
Download

Similar Content
Loading...
Loading...
Loading...
Abstract
BACKGROUND
Latest World Health Organization guidelines recommend shifting away from Stavudine (d4T)-based regimens due to severe side effects. However, widespread replacement of d4T by Tenofovir (TDF) or Zidovudine (AZT) is hampered by cost concerns.

METHODS
We established the cost-effectiveness of alternative first-line regimens using primary utilization, cost, and outcome data from a program in a rural district in Lesotho. We calculated cost per patient-year, incremental costs, and incremental cost-effectiveness ratios per life year, and per Quality Adjusted Life Year gained. Uncertainty was assessed using multiway and probabilistic sensitivity analyses.

RESULTS
Our study included 1260 patients representing 1635 patient-years on antiretroviral therapy (ART). Six hundred eight patients were on TDF, 290 were on AZT, and 362 were on d4T. Patients on d4T experienced more toxicities; toxicities with the biggest impact on quality of life were moderate neuropathy and severe lipodystrophy. The cost per patient-year ranged from US $266 on d4T to US $353 on TDF. Inpatient care and essential drug costs were higher for patients on d4T than on AZT or TDF. Incremental cost-effectiveness ratio results suggest that AZT-based ART is weakly dominated by a combination of d4T- and TDF-based ART.

DISCUSSION
This is one of the first analyses to investigate the cost-effectiveness of TDF using primary data in a resource-poor setting. Although TDF-based first-line ART is more costly than d4T, it is also more effective. Political pressure should be exerted to encourage further price reductions and additional generic manufacturing for TDF and partner drugs such as Efavirenz. This should be met by a commitment from donors and implementers to ensure that supply is met by a clear demand.

Countries

Lesotho

Subject Area

models of care

Languages

English
DOI
10.1097/QAI.0b013e31822a9f8d
Published Date
01 Nov 2011
PubMed ID
21765366
Journal
Journal of Acquired Immune Deficiency Syndromes (1999)
Volume | Issue | Pages
Volume 58, Issue 3, Pages e68-74
Issue Date
2011-11-01
Dimensions Badge