Abstract
Background: A prospective cost-effectiveness analysis undertaken as part of the CAESAR (Canada, Australia, Europe, South Africa) placebo-controlled clinical trial showed that adding lamivudine to zidovudine-containing regimens for 1 year reduced progression to AIDS or death and, in addition, significantly reduced the number of hospitalisations, unscheduled outpatient visits and the requirement for medications for HIV-related illness. Data from all 1840 patients included in the intent-to-treat population of the CAESAR trial were used in the analysis reported in this paper. Because a third-party payer perspective was adopted, possible savings associated with increased productivity (indirect costs) were not taken into account. All costs were adjusted to 1997 prices.
Results: The savings associated with reduced healthcare resource use in the CAESAR study were estimated to be 3045 Deutschmarks (DM) [German analysis] or 432 pounds sterling (£) [UK analysis] per patient for the 1-year time period. These savings partly offset the cost of lamivudine in the 2 countries. The German analysis showed that the addition of lamivudine to zidovudinecontaining regimens resulted in an incremental cost-effectiveness ratio of DM22 405 [95% confidence interval (CI): DM2199 to DM59 154] for progression to AIDS/death avoided and of DM8869 (95% CI: DM1047 to DM23 365) for HIV-related illness avoided. The corresponding ratios for the UK analysis were £12 030 (95% CI: £6752 to £21 888) for progressions avoided and £4762 (95% CI: £2796 to £9484) for new and recurrent HIV-related illness avoided.
Conclusions: Our findings indicate that treatments that slow the progression of HIV infection to AIDS or death have the potential to facilitate healthcare savings during the period that the treatment is effective. The results also demonstrate that it is possible to undertake economic evaluations in parallel with a major clinical end-point study.
Similar content being viewed by others
References
Forte P, Bowen T. HIV/AIDS care and treatment costs: forward planning. London: AIDS Awareness Trust, 1996
Moore RD, Bartlett JG. Combination antiretroviral therapy in HIV infection: an economic perspective. Pharmacoeconomics 1996; 10 (2): 109–13
Mouton Y, Alfandari S, Valette M, et al. Impact of protease inhibitors on AIDS-defining events and hospitalizations in 10 French AIDS reference centres. AIDS 1997 Oct; 11 (12): F101–5
Torres R, Barr M. Impact of potent new antiretroviral therapies on in-patient and out-patient hospital utilization by HIVinfected persons [abstract 264]. 4th International Conference on Retroviruses and Opportunistic Infections; 1997 Jan 22- 26; Washington DC, 113
Randomized trial of addition of lamivudine or lamivudine plus loviride to zidovudine-containing regimens for patients with HIV-1 infection: the CAESAR trial. Lancet 1997; 349: 1413–21
Gill J, Lacey L, Gibson A, et al. Impact of lamivudine or lamivudine plus loviride on healthcare resource use in patients with HIV [abstract: N25]. 37th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). 1997 Sep 28-Oct 1; Toronto, Canada, 386
Gill J, Lacey L, Gibson A, and the CAESAR Co-Ordinating Committee. Reduction in healthcare resource use in patients with HIV-1 receiving lamivudine (3TC) in addition to their current zidovudine-containing treatment [abstract 218]. 6th European Conference on Clinical Aspects and Treatment of HIV Infection; 1997 Oct 11-15; Hamburg, Germany, 1997: 23
Lacey L, Hill A, Mauskopf JA. The incidence of opportunistic infections and hospitalisations in HIV patients treated with lamivudine/zidovudine [abstract P37]. 3rd International Conference on Drug Therapy in HIV Infection; 1996 Nov 3-7; Birmingham, UK. AIDS 1996; 10 Suppl. 1: S28
Staszewski S, Loveday C, Picazo JJ, et al. Safety and efficacy of lamivudine-zidovudine combination therapy in zidovudine-experienced patients. JAMA 1996; 276: 111–7
Chancellor JV, Hill AM, Sabin CA, et al. Modelling the cost effectiveness of lamivudine/zidovudine combination therapy in HIV infection. Pharmacoeconomics 1997; 12 (1): 54–66
British HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals. BHIVA Guidelines Co-ordinating Committee. Lancet 1997; 349 (9058): 1086–92
1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep 1992; 41 (RR-17): 1–19
British National Formulary. Number XX. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 1997
Rote Liste® Service GmbH, editor. Rote Liste® 1997. Frankfurt: EVC Editio Cantor Verlag, 1997
Statistisches Bundesamt. Gesundheitswesen: Fachserie 12, Reihe 6.2. Diagnosedaten der Krankhauspatienten — 1996. Wiesbaden: Metzler-Poeschel, Stuttgart, 1997
Hospital Episode Statistics, 1994 to 1995. Vol. 1. UK: Department of Health, 1996
Hospital and Community Health Services Pay and Price Index. In: Netten A, Dennett J, editors. University of Kent at Canterbury: Personal Social Services Research Unit (PSSRU), 1
Polsky D, Glick HA, Wilke R, et al. Confidence intervals for cost-effectiveness ratios: a comparison of four methods. Health Econ 1997; 6: 243–52
Lacey L, Gill MJ. Lamivudine reduces healthcare resource use when added to zidovudine-containing regimens in patients with HIV infection. Pharmacoeconomics 1999; 15 Suppl. 1: 13–22
ECO-Santé OECD 1997/OECD Health data 1997 [CD-ROM]. Paris: CREDES, 1997
Lacey L, Mauskopf J, Lindrooth R, et al. A prospective costconsequence analysis of adding lamivudine to zidovudinecontaining antiretroviral treatment regimens for HIV infection in the US. Pharmacoeconomics 1999; 15 Suppl. 1: 23–38
Brettle RP, Atkinson FI, Wilcock J, et al. The cost of health care for HIV-positive patients. Int J STD AIDS 1997 Jan; 8 (1): 50–3
Mouton Y, Alfandari S, Valette M, et al. Impact of protease inhibitors on AIDS defining events and hospitalisations in 10 French AIDS reference centres. AIDS 1997 Oct; 11 (12): F101–5
Beck E. Counting the cost of HIV service provision in England: where do we go from here? J HIV Comb Ther 1997; 2: 29–32
Beck EJ, Kupek EL, Wadsworth J, et al. The use and cost of hospital services by London AIDS patients with different AIDS defining conditions. J Public Health Med 1996; 18 (4): 457–64
Curtis H. Funding implications of combination therapies. J HIV Comb Ther 1997; 2: 27–8
Mauskopf JAL, Lacey LA, Kempel A, et al. The cost-effectiveness of treatment with lamivudine and zidovudine compared to zidovudine alone: a comparison of Markov model and trial data estimates. Am J Managed Care 1998; 4 (7): 1004
Adams ME, McCall NT, Gray DT, et al. Economic analysis in randomized control trials. Med Care 1992 Mar; 30 (3): 231–43
New UK guidance on economic evaluation. SCRIP 1994; 1926: 3
A first class service. Quality in the new National Health Service (NHS). London: Department of Health, 1998
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lacey, L., Youle, M., Trueman, P. et al. A Prospective Evaluation of the Cost Effectiveness of Adding Lamivudine to Zidovudine-Containing Antiretroviral Treatment Regimens in HIV Infection. Pharmacoeconomics 15 (Suppl 1), 39–53 (1999). https://doi.org/10.2165/00019053-199915001-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199915001-00004