PIN3 Is Dolutegravir Cost Effective in Treating Patients Living with HIV

Dolutegravir (DTG) in combination with NRTIs is one of the recommended regimens in both treatment-experienced/naïve people living with HIV (PLHIV). This review was conducted to summarise the economic evidence available with various recommended regimens of DTG (mono, dual and triple therapy) in PLHIV. A literature review was conducted using PubMed, Embase (1-Jan-2010 to-17-Dec-2019). The searches were supplemented with conference abstracts/posters (last five-years) and evidence from HTA bodies. Of 1,445 publications screened for economic evaluation on DTG, 25 assessed DTG in treatment-naïve, 17 in treatment-experienced and 14 with mixed-population. Most studies were conducted in Europe (n=18), followed by the US/Canada (n=16). Thirty-four publications assessed cost-effective/cost-utility analysis for DTG/3TC/ABC (n=11); DTG monotherapy (n=8); DTG/3TC (n=5); DTG/RPV (n=3). Common regimens studied against DTG were raltegravir, efavirenz and elvitegravir based regimens. Quality-adjusted life-years (QALYs), LYs, incremental cost per QALY ratio were some of the commonly studied outcomes. Most studies were conducted using payer-perspective over a life-time horizon. DTG regimens were cost-effective in twenty-seven publications, which was consistent across geographies. Key-driver of costs-effectiveness was lower DTG costs, and to a lesser extent, reduced costs associated with adverse-events. With its superior efficacy and high barrier to resistance, DTG/3TC/ABC was considered as cost-effective and preferred regimen with incremental QALYs ranging from 0.001 to 0.28. DTG/3TC in particular was dominant with incremental QALYs ranging from -0.037 to 0.203 and cost-savings from $41,212-$157080 against various three drug-regimen (3DR). Similar results were observed with DTG/RPV. Switching to DTG dual-therapy was thus observed as a cost-effective approach in addition to aiding simplification. Three studies found that DTG-3DR was not cost-effective, which could be attributed to limitations in the model-inputs or trial design used to populate the model. With lower cost across geographies, higher QALYs gained, DTG was considered as cost-effective treatment in both experienced/naïve patients.