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The price of change – Replacing Stavudine with Tenofovir in first-line ART in scaling-up settings

The price of change – Replacing Stavudine with Tenofovir in first-line ART in scaling-up settings XVII International AIDS Conference Mexico City, 7th August 2008 Jari Kivela Health Economist jari.kivela@qalys.eu. Background. WHO recommendation to replace d4T Scaling-up

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The price of change – Replacing Stavudine with Tenofovir in first-line ART in scaling-up settings

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  1. The price of change – Replacing Stavudine with Tenofovir in first-line ART in scaling-up settings XVII International AIDS Conference Mexico City, 7th August 2008 Jari Kivela Health Economist jari.kivela@qalys.eu

  2. Background • WHO recommendation to replace d4T • Scaling-up • Problem: How much will it cost? • Tool: Health economic model

  3. Objectives Develop a model to: • Support decision making • Demonstrate budget impacts • Compare timing of introdcution • Forecast ART budget 2008 - 2014

  4. Tenofovir (TDF) WHO recommendation Better toxicity profile Once a day dosing TDF $128 PPY Stavudine (d4T) d4T $19 PPY Significant toxicitìes Fixed dose combination:d4T / 3TC / NVP30mg / 150mg / 200mg Tenofovir vs. Stavudine

  5. Current first-line regimen d4T NVP 3TC

  6. New improved first-line regimen d4T NVP 3TC TDF EFV

  7. Price of d4T/3TC/NVP

  8. Price of TDF/3TC/EFV

  9. ART survival and 2nd-line switch rate • Global Cohort MSF57.000 ART patients • Extrapolated after 48 months • ART survival 9.7 years • 2nd-line switching rate

  10. Epworth Program Epworth, Harare township • Population 400.000 • 20% infected with HIV MSF program • 6.000 HIV+ patients • 1.400 on ART • First ARTs April 2007 • 150 new patients / month

  11. 150 new ART patients / month

  12. Methods • Patient volumeNr of patients, speed of scaling-up • Medical dataART regimens, ART survival, rate of switch to 2nd-line, CD4 baselines • Financial informationForecasted ART prices, actual expenditures, annual budget • Sensitivity analyses

  13. Base case: All patients on d4T/3TC/NVP $1.8M

  14. All patients on TDF/3TC/EFV 2008 $8.8M $1.8M

  15. Only new patients on TDF/3TC/EFV 2008 $8.8M $8.8M $7.6M $1.8M $1.8M

  16. Only new patients on TDF/3TC/EFV 2009 $8.8M $6.1M $1.8M

  17. Only new patients on TDF/3TC/EFV 2010 $8.8M $4.7M $1.8M

  18. Limitations • Potential cost savings:From better toxicity profile of TDF • ART price development • Inadequate TDF survival data

  19. Summary • Useful tool to forecast costs • High cost of TDF and EFV • Major barrier in resource poor settings

  20. d4T NVP 3TC

  21. d4T NVP 3TC TDF

  22. All patients on TDF/3TC/NVP 2008 $6.6M $1.8M

  23. ART Prices

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