A prospective evaluation of the cost effectiveness of adding lamivudine tozidovudine-containing antiretroviral treatment regimens in HIV infection -European perspective

Background: A prospective cost-effectiveness analysis undertaken as part of the CAESAR (Canada, Australia, Europe, South Africa) placebo-controlled cl inical trial showed that adding lamivudine to zidovudine-containing regimen s for 1 year reduced progression to AIDS or death and, in addition, signifi cantly reduced the number of hospitalisations. unscheduled outpatient visit s and the requirement for medications for HIV-related illness. Data from al l 1840 patients included in the intent-to-treat population of the CAESAR tr ial 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 a djusted 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 (pound) [UK analysis] per patient for the 1-year ti me period. These savings partly offset the cost of lamivudine in the 2 coun tries. The German analysis showed that the addition of lamivudine to zidovu dine-containing regimens resulted in an incremental cost-effectiveness rati o of DM22 405 [95% confidence interval (CI): -DM2199 to DM59 154] for progr ession to AIDS/death avoided and of DM8869 (95% CI: -DM1047 to DM23 365) fo r HIV-related illness avoided. The corresponding ratios for the UK analysis were pound 12 030 (95% CI: pound 6752 to pound 21 888) fur progressions av oided and pound 4762 (95% CI: pound 2796 to pound 9384) for new and recurre nt HIV-related illness avoided. Conclusions: Our findings indicate that treatments that slow the progressio n of HIV infection to AIDS or death have the potential to facilitate health care 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.