Cost-effectiveness of a 4 days-a-week triple therapy in persons living with HIV: an ancillary study of the ANRS 170 QUATUOR noninferiority trial
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Background
ANRS 170 QUATUOR study ( NCT03256422 ) demonstrated the noninferiority of a triple antiretroviral therapy (ART) taken 4 days a week (4/7-days) compared to a triple therapy taken 7 days a week (7/7-days) for persons living with HIV and with suppressed viremia. We aimed at investigating corresponding cost-effectiveness issues.
Methods
All persons involved in the primary analysis of the QUATUOR noninferiority trial were considered (N=636, 318 per arm) in this cost-effectiveness study. Time horizon was the first 48 weeks of the trial. Effectiveness was considered as the noninferiority of the 4/7-days strategy, main criterion of the trial primary analysis. Direct health resource costs ( year2022 €) were considered and included costs for ART, laboratory tests, co-medications, hospitalizations, and medical consultations. Analyses were based on 10,000 simulations replicating the trial. Additional analyses explored the national impact of spreading the 4/7-days strategy all over France. Sensitivity analyses included considering treatment success as effectiveness, and various proportions of persons adopting the 4/7-days strategy.
Findings
The mean individual total costs amounted to € 5,049 [95% confidence interval: 4,798–5,345] and € 8,089 [7,706–8,527] in the 4/7-days and 7/7-days arm, respectively. Corresponding ART costs were € 3,678 [3,593–3,763] and € 6,450 [6,301–6,596], respectively (p<0.0001), and constituted the single cost element with a statistical difference between the two strategies. Considering noninferiority as the effectiveness criterion in a health economic perspective, the 4/7-day strategy provided average savings of € 3,013 [2829–3196] in ART costs per individual and per year. Adopting the 4/7-days regimen in 20% of the potential recipients in France was estimated to provide annual savings of € 61,752,467 [61,569,005; 61,925,136].
Interpretation
The 4/7-day strategy dominates the 7/7-day strategy since it spares substantial ART costs while maintaining treatment effectiveness. Study results support generalizing the adoption of 4/7-days triple ART regimens in France, when possible.
