Evidence map›Paper›PMID 26966125›Full record

ArticlePharmacoEconomics2016

Cost Effectiveness of Protease Inhibitor Monotherapy Versus Standard Triple Therapy in the Long-Term Management of HIV Patients: Analysis Using Evidence from the PIVOT Trial.

Lars Oddershede, Simon Walker, Wolfgang Stöhr, David T Dunn, Alejandro Arenas-Pinto, Nicholas I Paton, Mark Sculpher, Protease Inhibitor monotherapy Versus Ongoing Triple therapy (PIVOT) Trial Team

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in PharmacoEconomics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Observational
  6. Observational
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Lars OddershedeThe Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Aalborg, Denmark.
Simon WalkerCentre for Health Economics, The University of York, York, YO10 5DD, UK. smw501@york.ac.uk.
Wolfgang StöhrMRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK.
David T DunnMRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK.
Alejandro Arenas-PintoMRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK.
Nicholas I PatonMRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK.
Mark SculpherCentre for Health Economics, The University of York, York, YO10 5DD, UK.
Protease Inhibitor monotherapy Versus Ongoing Triple therapy (PIVOT) Trial Team

Funding

Department of Health 06/403/501Department of Health 06/403/90Department of Health HTA/06/403/501Medical Research Council MC_UU_12023/23
6 · The paper itself

Abstract

backgroundProtease inhibitor (PI) monotherapy can maintain virological suppression in the majority of patients once it has been established on triple therapy and may also have the potential for substantial cost savings arising from the use of fewer drugs. However, the cost effectiveness of PI monotherapy has yet to be demonstrated.

objectivesIn this study we examine the cost effectiveness of PI monotherapy with prompt return to combination therapy in the event of viral load rebound compared with ongoing triple therapy (OT) in patients with suppressed viral load on combination antiretroviral therapy (ART) in the UK.

methodsThe analysis used data from the PIVOT trial in which HIV-positive adults with suppressed viral load for ≥24 weeks on combination ART were randomised to maintain OT or to a strategy of PI monotherapy with prompt return to combination therapy if viral load rebounded. A cost-effectiveness analysis including long-term modelling was conducted. Main outcomes included UK National Health Service (NHS) costs and quality-adjusted life-years (QALYs) with comparative results presented as incremental cost-effectiveness ratios.

resultsPI monotherapy was cost saving as a result of large savings in ART drug costs while being no less effective in terms of QALYs in the within-trial analysis and marginally less effective with lifetime modelling. In the base-case analysis over 3 years, the incremental total cost per patient was -£6424.11 (95 % confidence interval -7418.84 to -5429.38) and incremental QALYs were 0.0051 (95 % CI -0.0479 to 0.0582), resulting in PI monotherapy 'dominating' OT. Multiple scenario analyses found that PI monotherapy was cost saving with no marked differences in QALYs. Modelling of lifetime costs and QALYs showed that PI monotherapy was associated with significant cost savings and was marginally less effective; PI monotherapy was cost effective at accepted cost-effectiveness thresholds in all but one scenario analysis.

conclusionsUnder most assumptions, PI monotherapy appears to be a cost-effective treatment strategy compared with OT for HIV-infected patients who have achieved sustained virological suppression.

Indexed as

Models, EconomicQuality-Adjusted Life YearsAdultAnti-HIV AgentsCost-Benefit AnalysisCost SavingsDrug Therapy, CombinationFemaleHIV InfectionsHIV Protease InhibitorsHumansMaleRandomized Controlled Trials as TopicTreatment OutcomeUnited KingdomViral LoadAnti-HIV AgentsHIV Protease Inhibitors

Identifiers

PMID26966125

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.