Abstract：
OBJECTIVE: Dolutegravir (DTG) has proved to be more efficacious, tolerable, and safer than efavirenz (EFV) among mothers living with HIV and their infants in Uganda. This study assessed the cost-effectiveness of the DTG-based antiretroviral therapy (ART) compared with the standard of care for preventing perinatal transmissions among pregnant women initiating ART in late pregnancy in Uganda.
METHODS: We used data from a randomized open-label trial (DolPHIN-2) and a 2-part cost-effectiveness model composed of a short-term decision tree to estimate the perinatal transmission rate and costs and an individual-based 3-state Markov model (HIV, advanced HIV, dead) to estimate the long-term costs and health outcomes from the Ugandan payer perspective using a lifetime horizon and a 1-year Markov cycle. The main outcomes were the mean annual costs in US dollars ($), disability-adjusted life-years (DALYs), and incremental cost-effectiveness ratio. Both the deterministic and probabilistic sensitivity analyses were conducted to assess the effect of parameter uncertainties on the ultimate results and the model\'s robustness.
RESULTS: Compared with the EFV-based ART, the DTG-based ART was associated with fewer mean annual costs ($43.58 vs $68.44) and DALYs (0.33 vs 0.56), leading to cost savings of $110 per DALY averted. In the incremental analysis, the DTG-based ART dominated the EFV-based ART; that is, it was less costly and more effective. These results were robust to deterministic and probabilistic sensitivity analyses.
CONCLUSIONS: The DTG-based ART is a highly cost-effective strategy compared with the EFV-based ART among women initiating treatment in the third trimester of pregnancy in a low-income setting.
METHODS: We used data from a randomized open-label trial (DolPHIN-2) and a 2-part cost-effectiveness model composed of a short-term decision tree to estimate the perinatal transmission rate and costs and an individual-based 3-state Markov model (HIV, advanced HIV, dead) to estimate the long-term costs and health outcomes from the Ugandan payer perspective using a lifetime horizon and a 1-year Markov cycle. The main outcomes were the mean annual costs in US dollars ($), disability-adjusted life-years (DALYs), and incremental cost-effectiveness ratio. Both the deterministic and probabilistic sensitivity analyses were conducted to assess the effect of parameter uncertainties on the ultimate results and the model\'s robustness.
RESULTS: Compared with the EFV-based ART, the DTG-based ART was associated with fewer mean annual costs ($43.58 vs $68.44) and DALYs (0.33 vs 0.56), leading to cost savings of $110 per DALY averted. In the incremental analysis, the DTG-based ART dominated the EFV-based ART; that is, it was less costly and more effective. These results were robust to deterministic and probabilistic sensitivity analyses.
CONCLUSIONS: The DTG-based ART is a highly cost-effective strategy compared with the EFV-based ART among women initiating treatment in the third trimester of pregnancy in a low-income setting.
摘要：
目的：Dolutegravir（DTG）已被证明更有效，可容忍,在乌干达感染艾滋病毒的母亲及其婴儿中，比法韦伦（EFV）更安全。这项研究评估了基于DTG的抗逆转录病毒疗法（ART）的成本效益，并与乌干达妊娠晚期开始ART的孕妇预防围产期传播的护理标准进行了比较。
方法：我们使用了来自随机开放标签试验（DolPHIN-2）和由短期决策树组成的2部分成本效益模型的数据来估计围产期传播率和成本以及基于个体的3状态马尔可夫模型（HIV，先进的艾滋病毒，dead）使用生命周期和1年马尔可夫周期从乌干达付款人的角度估计长期成本和健康结果。主要结果是以美元($)为单位的平均年成本，残疾调整寿命年(DALYs)，和增量成本效益比。进行了确定性和概率敏感性分析，以评估参数不确定性对最终结果和模型稳健性的影响。
结果：与基于EFV的ART相比，基于DTG的ART与较少的平均年度成本(43.58美元对68.44美元)和DALYs(0.33对0.56)相关，避免每DALY节省110美元的成本。在增量分析中，基于DTG的ART主导了基于EFV的ART；也就是说，成本更低，效率更高。这些结果对于确定性和概率敏感性分析是稳健的。
结论：与基于EFV的ART相比，基于DTG的ART是一种在低收入环境中妊娠晚期开始治疗的女性的成本效益高的策略。
方法：我们使用了来自随机开放标签试验（DolPHIN-2）和由短期决策树组成的2部分成本效益模型的数据来估计围产期传播率和成本以及基于个体的3状态马尔可夫模型（HIV，先进的艾滋病毒，dead）使用生命周期和1年马尔可夫周期从乌干达付款人的角度估计长期成本和健康结果。主要结果是以美元($)为单位的平均年成本，残疾调整寿命年(DALYs)，和增量成本效益比。进行了确定性和概率敏感性分析，以评估参数不确定性对最终结果和模型稳健性的影响。
结果：与基于EFV的ART相比，基于DTG的ART与较少的平均年度成本(43.58美元对68.44美元)和DALYs(0.33对0.56)相关，避免每DALY节省110美元的成本。在增量分析中，基于DTG的ART主导了基于EFV的ART；也就是说，成本更低，效率更高。这些结果对于确定性和概率敏感性分析是稳健的。
结论：与基于EFV的ART相比，基于DTG的ART是一种在低收入环境中妊娠晚期开始治疗的女性的成本效益高的策略。
