CLINICOECONOMIC ANALYSIS OF THE USE OF MARAVIROC VERSUS OTHER RESERVE DRUGS IN PATIENTS WHO HAVE EXPERIENCED ANTIRETROVIRAL THERAPY FOR HIV INFECTION

Objective. To make a clinicoeconomic estimate of maraviroc versus raltegravir, darunavir, etravirine, and enfuvirtide used as part of reserve treatment regimens for HIV infection in patients who had previously received antiretroviral therapy (ART). Materials and methods. The results of randomized controlled trials were used to make an indirect comparison of the clinical efficacy and safety of the test drugs applied in combination with optimized basic therapy. Relying on the comparison, the authors made a cost minimization analysis, in which a Microsoft Excel-based model was used to estimate the costs of the antiretroviral drugs (maraviroc, raltegravir, darunavir, and enfuvirtide) and averaged basic therapy (regimens containing medicines from the groups of nucleoside reverse transcriptase inhibitors and protease inhibitors), and a follow-up of HIV-infected patients. Comparison of maraviroc with etravirine as part of reserve ART regimens, by taking into account the indirect comparison data on the higher efficacy of the former, required the use of a cost-effectiveness analysis, but the latter was not done in this study. The impact of incorporation of maraviroc into the standard of primary health care for HIV-induced disease on the health care budget was additionally analyzed. Calculations were based on the manufacturers’ registered maximum release prices of drugs from the list of vital and essential medicines and on the standards of f inancial costs in the health system of the Russian Federation. Results. The comparable efficacy, safety, and less cost of maraviroc versus those of raltegravir, darunavir, and enfuvirtide as part of reserve AR T regimens can substantially reduce the cost of treatment. The cost saving for maraviroc per patient versus that of raltegravir will average 177764.16 rubles during 48 weeks of therapy and 340714.64 rubles during 96 weeks; versus that of darunavir was 59929.92 and 114865.68 rubles, respectively; that of enfuvirtide was 462295.92 and 886067.18 rubles, respectively. The incorporation of maraviroc with 2% frequency into the standard of primary health care for HIV infection into the section «Other antiviral drugs» (JO5AX) will be able to lower federal expenditures by an average of 6933.98 rubles per patient yearly, which will, in terms of the number of patients receiving ART, amount to 808307916.56 rubles (according to the data as of October, 2013).

maraviroc, raltegravir, enfuvirtide, darunavir, entravirine, HIV infection, antiretroviral therapy, clinicoeconomic analysis, indirect comparison