India will be able to replace efavirenz with doltegravir without additional costs in first-line therapy
Antiretroviral therapy based on dolutegravir (DTG) should be preferred for first line HIV therapy, according to a report by a group of Indian researchers who studied the cost effectiveness of DTG. At the moment, the country's health authorities recommend the use of cheaper efavirenz (EFV) therapy. However, according to the authors of the study, switching DTG patents in India in the foreseeable future will make the price comparable to that of EFV.
As noted in an article published in the Journal of the International AIDS Society, studies in the US and Europe, where DTG is recommended as a priority treatment option, have shown that the drug has less pronounced side effects, allows faster reduction in viral load and with less probability of resistance. As a result, the use of DTG in these countries has significantly reduced the number of people who did not receive a therapeutic response during the first line therapy or were forced to switch to second-line ART.
The authors of the study used a mathematical model of the effect of replacing efavirenz with dolutegravir on the clinical and economic effect of treatment and found that using DTG for first line therap would be economically more efficient and potentially reduce costs to India's public health system.
The model presented by the scientists showed that 90% of people taking DTG within 48 weeks achieved undetectable viral load. in comparison with 82% of patients on EFV. Doloutegravir is also projected to reduce the mortality rate among PLHIV in a five-year horizon from 23% to 17%.
The researchers found that DTG has the potential to prevent 13,000 new HIV cases within five years, equivalent to a 20% reduction in HIV incidence and a saving of $800,000 in estimated treatment costs.
Thus, taking into account all factors, the costs of treatment and care for people living with HIV beginning treatment with efavirenz are estimated at $139 million over two years and $590 million over five years.
For comparison, the forecast of costs for treatment and care for people living wth HIV starting therapy with dolutegravir for two years was lower - $137 million, and the same for five years (590 million). There is an increase foreseen in the cost of treatment in the long term which the authors of the model associate with the fact of increasing the life expectancy of PLHIV and the increase in the cost of lifelong treatment.
As a result, the authors of the study conclude that after the expiration of the patents for dolutegravir and the appearance of generic versions of the drug on the Indian market, provided that its price does not exceed $180 per person per year, it will be economically expedient to replace it wth first-line therapy efavirenz.