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Determining the opportunity costs of using more expensive first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and stavudine Jennifer Campbell, Erin Koehler, Shaffiq Essajee , Elya Tagar, Megan O’Brien Vienna – July 2010 . Background.

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Determining the opportunity costs of using more expensive first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and stavudine

Jennifer Campbell, Erin Koehler, Shaffiq Essajee, Elya Tagar, Megan O’Brien

Vienna – July 2010


Background
Background first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and

Will treatment costs outpace available resources?

Flatlining budgets

HIV Treatment funding

+

=

Year

Cost of 1L treatment with AZT or TDF instead of d4T

Total HIV treatment program costs

Number of patients requiring treatment


Background key questions
Background: Key questions first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and

a. What are the benefits of a more expensive first line regimen with better toxicity and durability profile?

b. What is the opportunity cost in terms of patients not treated, given a set budget?


Methodology calculator design
Methodology: Calculator design first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and

10 year forecast of costs, based on 2013 ARV prices

MS Excel-based “closed cohort” analysis of 100,000 patients

Costs include 1st and 2nd line ARVs and toxicity costs

Permits modeling of scenarios where inputs such as estimated improvements in toxicity rates, toxicity treatment costs and migration to 2nd line can be compared with ARV treatment costs

Also permits modeling of reduction in loss to follow-up and mortality associated with “better” regimens


Methodology input screen shot
Methodology: Input screen shot first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and


Results screen shot
Results: first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and Screen shot


Results opportunity cost for selecting a tdf based regimen
Results: opportunity cost for selecting a TDF-based regimen first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and


Results opportunity cost for selecting a tdf based regimen1
Results: opportunity cost for selecting a TDF-based regimen first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and

Cost for 100K patients for 10 years

Patient years treated

182K

25M

104M

79M

569K

569K

* Cost includes toxicity, 1L and 2L ARVs


Conclusions
Conclusions first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and

  • In addition to the break-even analysis, the calculator can estimate the likely net cost of more expensive regimens with the joint savings from reduced toxicity and improved durability.

  • This additional cost is translated into the patient-years of treatment that could be purchased with a cheaper regimen.

  • Tools like this one allow us to better understand the impact of more expensive, more effective regimen on access to treatment.


Conclusions1
Conclusions first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and

  • Scenarios like this suggest that a one-size-fits-all change to more expensive regimens may not be advisable.

  • Countries with constrained budgets and/or low coverage may want to consider starting subsets of patients on more expensive regimens, but leaving others on D4T to maintain scale-up


Thank you
Thank you first line regimens with regard to treatment access in resource limited settings: A look at tenofovir and

Meg O’Brien

Jennifer Campbell

ElyaTagar

Erin Koehler


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