A Prospective Evaluation of the Cost Effectiveness of Adding Lamivudine to Zidovudine-Containing Antiretroviral Treatment Regimens in HIV Infection

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Abstract
Background: A prospective cost-effectiveness analysis undertaken as part of the CAESAR (Canada, Australia, Europe, South Africa) placebo-controlled clinical trial showed that adding lamivudine to zidovudine-containing regimens for 1 year reduced progression to AIDS or death and, in addition, significantly reduced the number of hospitalisations, unscheduled outpatient visits and the requirement for medications for HIV-related illness. Data from all 1840 patients included in the intent-to-treat population of the CAESAR trial 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 adjusted 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 (£) [UK analysis] per patient for the 1-year time period. These savings partly offset the cost of lamivudine in the 2 countries. The German analysis showed that the addition of lamivudine to zidovudinecontaining regimens resulted in an incremental cost-effectiveness ratio of DM22 405 [95% confidence interval (CI): DM2199 to DM59 154] for progression to AIDS/death avoided and of DM8869 (95% CI: DM1047 to DM23 365) for HIV-related illness avoided. The corresponding ratios for the UK analysis were £12 030 (95% CI: £6752 to £21 888) for progressions avoided and £4762 (95% CI: £2796 to £9484) for new and recurrent HIV-related illness avoided. Conclusions: Our findings indicate that treatments that slow the progression of HIV infection to AIDS or death have the potential to facilitate healthcare 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.