COST-EFFECTIVENESS OF MONOTHERAPY VS. COMBINATION THERAPY FOR HIV MANAGEMENT INDIA PERSPECTIVE: A MARKOV MODEL ANALYSIS
Author(s)
Afroz H. Khateeb, PhD;
Jawaharlal Nehru Medical college, Wardha, India
Jawaharlal Nehru Medical college, Wardha, India
OBJECTIVES: To assess the cost-effectiveness (CE) of zidovudine monotherapy vs. zidovudine plus lamivudine combination therapy for treatment of HIV in India using a Markov model.
METHODS: A markov model was used to assess the CE of the zidovudine monotherapy vs. zidovudine plus lamivudine combination therapy using a lifetime horizon from a healthcare payer perspective and discount rate (3-6%). Cost reported in USD. The model simulated approximately thousand patients across four health states over 50 annual cycles. Outcomes included discounted costs, life-years, and quality-adjusted life-years (QALYs). Willingness-to-pay (WTP) thresholds were benchmarked to India’s GDP per capita (USD $2,396) and opportunity-cost-based ranges (USD $1,194-$3,594 per QALY).
RESULTS: Combination therapy yielded 20,699 life-years and 17,594 QALYs vs. 5,819 life-years and 4,945 QALYs for monotherapy. Incremental gains were reported 14,881 life-years and 12,649 QALYs. Total discounted costs were USD $30.36 million for monotherapy and USD $85.83 million for combination therapy, with an incremental cost of USD $55.47 million. The incremental cost-effectiveness ratio (ICER) was approximately US$4,385/QALY and US$4,385 per life-year gained, close to the upper bound of WTP but favorable under opportunity-cost reasoning.
CONCLUSIONS: Combination therapy offers substantial survival and quality of life benefits at acceptable incremental cost in India. Strategy is highly likely to be cost-effective under moderate WTP thresholds. These findings support prioritization of combination ART within national guidelines and strategies, however further research is warranted.
METHODS: A markov model was used to assess the CE of the zidovudine monotherapy vs. zidovudine plus lamivudine combination therapy using a lifetime horizon from a healthcare payer perspective and discount rate (3-6%). Cost reported in USD. The model simulated approximately thousand patients across four health states over 50 annual cycles. Outcomes included discounted costs, life-years, and quality-adjusted life-years (QALYs). Willingness-to-pay (WTP) thresholds were benchmarked to India’s GDP per capita (USD $2,396) and opportunity-cost-based ranges (USD $1,194-$3,594 per QALY).
RESULTS: Combination therapy yielded 20,699 life-years and 17,594 QALYs vs. 5,819 life-years and 4,945 QALYs for monotherapy. Incremental gains were reported 14,881 life-years and 12,649 QALYs. Total discounted costs were USD $30.36 million for monotherapy and USD $85.83 million for combination therapy, with an incremental cost of USD $55.47 million. The incremental cost-effectiveness ratio (ICER) was approximately US$4,385/QALY and US$4,385 per life-year gained, close to the upper bound of WTP but favorable under opportunity-cost reasoning.
CONCLUSIONS: Combination therapy offers substantial survival and quality of life benefits at acceptable incremental cost in India. Strategy is highly likely to be cost-effective under moderate WTP thresholds. These findings support prioritization of combination ART within national guidelines and strategies, however further research is warranted.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE294
Topic
Economic Evaluation
Disease
SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)