Cost-Effectiveness Analysis of Nevirapine vs. Ritonavir-Boosted Lopinavir in HIV-infected Children With Peripartum Nevirapine Exposure In Resource-Constrained Areas From Payer's Perspective

BACKGROUND: A regimen including nevirapine (NVP) is often the predominant antiretroviral therapy (ART) available for children infected with HIV in Africa, because it is inexpensive, stable at high temperature, and available in fixed dose combination. Despite the benefits of NVP, challenges exist from the effect of NVP resistance in children who become infected with HIV regardless of prophylaxis. As a result of these concerns, ritonavir-boosted lopinavir (LPV/r) based regimens, although more expensive, are preferred over the less costly NVP-based regimens.;OBJECTIVE: To evaluate the cost-effectiveness of NVP-based regimens to LPV/r-based regimens as a first-line treatment option for children with HIV after virologic suppression.;METHODS: Markov Modeling was designed to evaluate the cost-effectiveness of NVP-based regimens to LPV/r-based regimens for HIV-infected children with three HIV transition states, CD4%=>15, CD4%<15, and death. Sensitivity analyses were carried out to examine the stability or the robustness of the conclusion by varying base case assumptions on the costs and discount rates. The model was based on one-year, three-year, and a lifetime horizon. All the costs of the healthcare and the benefits of the healthcare were discounted at both 3% and 5% annually, at a willingness to pay threshold of US;RESULTS: The Incremental Costs Effectiveness Ratio (ICERs) compares the incremental cost per additional unit effectiveness of the different strategies. The resultant ICERs from this study based on the cost and effectiveness demonstrate that the strategy consisting of NVP is the preferred option, with the incremental cost and the incremental QALY of one-year time horizon, three-year time horizon, and lifetime horizon of, ;CONCLUSION: For HIV-infected children with a history of exposure to sdNVP from PMTCT prophylaxis, it is cost-effective to switch to NVP-based regimens after virologic suppression with LPV/r-based therapy, as a first-line treatment option.