OBJECTIVES : In China, long-term use of conventional drugs treating acquired immunodeficiency syndrome (AIDS) is associated with toxicity, adverse effects (AEs), and poor compliance. On January 1, 2020, elvitegravir, cobicistat/emtricitabine/tenofovir alafenamide fumarate tablets (E/C/F/TAF) were included in the Chinese National Medical Insurance list. E/C/F/TAF is a fixed-dose-combination tablet for once-daily administration. This study assessed the cost-effectiveness of E/C/F/TAF vs other combination regimens for the treatment of AIDS from the Chinese payer perspective.

METHODS : A long-term Markov model simulated the progression of a hypothetical cohort of patients with AIDS over a lifetime. It considered all patients, and subgroups of treatment-naïve and virologically suppressed, treatment-experienced patients. E/C/F/TAF was compared with abacavir/dolutegravir/lamivudine (DTG/ABC/3TC), and tenofovir/alafenamide/emtricitabine plus raltegravir (TAF/FTC+RAL) or plus dolutegravir (TAF/FTC+DTG). A network meta-analysis identified clinical and safety data and synthesized available evidence into relative treatment effects between comparators. The effectiveness outcome was quality-adjusted life-years (QALYs). Direct, medication, and test and monitoring costs were included. Data sources for comorbidities, AEs, utilities, and costs included published literature and expert opinion. Costs and outcomes were discounted at 5%.

RESULTS : For Chinese AIDS patients with different cardiovascular risks, whether naïve or pretreated, E/C/F/TAF reduced treatment failure rate, incidence of cardiovascular disease, and progression to end-stage renal disease. E/C/F/TAF resulted in 9.29 QALYs over a lifetime, which was higher than all other comparators (DTG/ABC/3TC: 9.28; TAF/FTC+RAL: 9.27; TAF/FTC+DTG: 9.28). The clinical effectiveness of E/C/F/TAF led to reduced unnecessary expenses, and the lowest total cost of treatment vs other comparators (lifetime cost 816,951 CNY vs 889,754, 1,041,398, 892,384 CNY for DTG/ABC/3TC, TAF/FTC+RAL, and TAF/FTC+DTG, respectively). E/C/F/TAF remained cost-effective throughout a range of sensitivity analyses where key assumptions were tested.

CONCLUSIONS : Compared with other antiviral regimens, E/C/F/TAF has favourable effectiveness and safety. Additionally, its total treatment cost is the lowest, and thus it has a favourable cost-saving advantage for Chinese AIDS patients.