OBJECTIVES: Cabotegravir and rilpivirine long-acting (CAB LA + RPV LA) is the first injectable therapy for the treatment of HIV-1. CAB LA + RPV LA has demonstrated non-inferiority to conventional daily oral regimens in virologically suppressed People Living with HIV (PLHIV). As directly observed therapy administered every two months, it has the potential to address challenges associated with oral therapy including suboptimal adherence. Here, the cost-effectiveness of CAB LA + RPV LA in treatment-experienced PLHIV in Taiwan is assessed.

METHODS: A hybrid decision tree and Markov cohort state transition model was used to evaluate the costs and outcomes associated with CAB LA + RPV LA and a pooled oral comparator. Data from the ATLAS/ATLAS-2M/FLAIR clinical trials were used to inform regimen efficacy. Health states were defined using viral load and CD4+ cell count, with death an absorbing state. Four therapy lines were included, with discontinuation due to tolerability, virologic or other reasons. Cost data was specific to Taiwan, based on a National Health Insurance Research Database costing study, published literature and input from clinical experts. The analysis accounts for three benefits of CAB LA + RPV LA: adherence benefits (with a 5% difference in adherence based on local data), the potential to further reduce onwards viral transmission, and higher health state utility values versus oral therapy from the ATLAS trial.

RESULTS: In the base case analysis, CAB LA + RPV LA was associated with an additional 0.094 Life Years and 0.264 Quality Adjusted Life Years and higher lifetime costs (NT$8,053,375.77 versus NT$7,546,238.06) per PLHIV versus the oral comparator. The Incremental Cost-Effectiveness Ratio (ICER) of CAB LA + RPV LA was NT$1,920,437.12, below the three times GDP WTP threshold (NT$2,515,623.00 per QALY).

CONCLUSIONS: CAB LA + RPV LA was found to be cost-effective versus oral therapies for treatment-experienced PLHIV in Taiwan.