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            <title xml:lang="en">Cost‑Effectiveness Analysis of Lopinavir/Ritonavir Monotherapy Versus Standard Combination Antiretroviral Therapy in HIV‑1 Infected Patients with Viral Suppression in France (ANRS 140 DREAM)</title>
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            <funder>This study was sponsored and funded by the French National Institute for Health and Medical Research–France Recherche Nord&amp;Sud Sida-HIV Hepatites (Inserm-ANRS), Paris, France. ANRS 140 DREAM trial was conducted with the support of AbbVie, Bristol- Myers Squibb and Gilead Science.</funder>
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                <title xml:lang="en">Cost‑Effectiveness Analysis of Lopinavir/Ritonavir Monotherapy Versus Standard Combination Antiretroviral Therapy in HIV‑1 Infected Patients with Viral Suppression in France (ANRS 140 DREAM)</title>
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                    <forename type="first">Luis</forename>
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                    <forename type="first">Jean-Luc</forename>
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                  <publisher>[Cham, Switzerland] : Springer International Publishing AG, [2017]-</publisher>
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              <p>BACKGROUND:Protease inhibitor monotherapy is a simplified treatment strategy for virally suppressed HIV-positive patients that has the potential for cost savings, as fewer drugs are used than with combination therapy. However, evidence for its economic value is limited.OBJECTIVES:We assessed the cost-effectiveness of lopinavir/ritonavir monotherapy followed by treatment intensification in case of viral load rebound versus combination antiretroviral therapy (cART) with efavirenz/emtricitabine/tenofovir in HIV-1 infected patients with viral suppression in the ANRS 140 DREAM trial.METHODS:DREAM was conducted in 36 French Hospitals between 2009 and 2013. For each treatment strategy, we estimated the unadjusted and multivariate-adjusted mean costs (in €, year 2010 values) and quality-adjusted life-years (QALYs) per patient, as well as incremental costs and QALYs per patient. We then assessed uncertainty using the cost-effectiveness acceptability curve, scenario analyses and cost-effectiveness price-threshold (CEPT) analysis.RESULTS:In the base-case analysis considering 2009-2013 antiretroviral drug (ARV) prices, adjusted incremental costs and QALYs were - €3296 (95% confidence interval [CI] - 5202 to - 1391) and 0.006 (95% CI - 0.021 to 0.033), respectively, over 2 years, suggesting that monotherapy was cost-effective with a probability of 100% at various cost-effectiveness thresholds. In scenario analyses considering 2018 ARV prices, monotherapy remained cost-effective but with a lower probability (94% vs. 100% in the base-case analysis). The current price of cART would have to decrease by 34% to be cost-effective with a probability of 95%.CONCLUSION:Monotherapy appears to be cost-effective compared with cART for virologically suppressed HIV-positive patients in France. CEPT analysis is a useful tool to identify the preferred strategy to adopt given that ARV prices change rapidly.TRIAL REGISTRATION:Clinicaltrials.gov identifier: NCT00946595.</p>
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              <org type="consortium">Members of the ANRS 140 DREAM Trial Study Group: members of the Scientific Committee : (Isabelle Cohen-Codar, Sandrine Couffin-Cadiergues, Dr Jean-Marie Poirier, Dr Isabelle Poizot-Martin, Cécile Rabian, Anne- Marie Taburet and Pr Yazdan Yazdanpanah), the Data Safety Monitoring Board (Pr Eric Bellissant, Dr Isabelle Pellegrin, Jonas Le Bail and Pr Stéphane De Wit), the event review committee (Dr Olivier Patey, Pr Elisabeth Rouveix and Pr Yazdan Yazdanpanah), the IMEA (Karine Amat, Aïda Benalycherif, Roland Landman and Babacar Sylla), the INSERM U1219 (Valérie Boilet, Vincent Bouteloup, Françoise Couturier, Adélaïde Perrier, Dr Caroline Roussillon, Monique Termote, Patrick Mercié), the AP-HP (Sami Kolta, Laurence Morand-Joubert), the INSERM UMR1252 (Bruno Spire) and ANRS (Soizic Le Mestre and Fanny Cardon).</org>
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