OBJECTIVES: DTG/3TC represents an important new two drug regimen (2DR) treatment option for people living with HIV (PLHIV), offering non inferior efficacy to a three drug regimen with exposure to fewer drugs. DTG/3TC was approved in China in treatment-naïve PLHIV in 2021/June and listed into NRDL since 2022/Jan. This model evaluates the cost-effectiveness of DTG/3TC versus EVG/c/TAF/FTC and BIC/TAF/FTC in China.

METHODS: A hybrid decision tree and Markov cohort state transition model was used to evaluate the expected lifelong costs and clinical outcomes associated with DTG/3TC compared to EVG/c/TAF/FTC and BIC/TAF/FTC. Health states correspond to both HIV-1 viral load and CD4 cell count levels, with death included as an absorbing state. Expected costs and outcomes were estimated over a lifetime horizon at 5% discount rate from a healthcare system perspective, and the incremental cost-effectiveness ratios (ICERs) were calculated.

Data from the GEMINI I and II clinical trials were used to inform the efficacy of DTG/3TC, and the efficacy of EVG/c/TAF/FTC and BIC/TAF/FTC were informed by network meta-analysis (NMA). The regimen of subsequent lines of therapy were determined based on clinical practice in China and data informing their efficacy was sourced from the literature. Costing information was sourced from the literature, public information in China and 2021 NRDL negotiation prices.

RESULTS: Comparing with both EVG/c/TAF/FTC and BIC/TAF/FTC, DTG/3TC in treatment-naïve PLHIV in China was dominant (i.e. greater QALYs (0.166 and 0.143 respectively) and greater LYs (0.179 and 0.154 respectively) at lower cost (-¥27,639.93 and -¥28,724.50 respectively) over a patient’s lifetime) Probabilistic sensitivity analyses confirmed that the base case results of the analysis are robust.

CONCLUSIONS: DTG/3TC is dominant versus EVG/c/TAF/FTC and BIC/TAF/FTC in treatment-naïve PLHIV in China and was associated with greater lifetime QALYs and LYs at lower cost.