Wenjuan Wang,1,* Dachuang Zhou,1,* Kejia Zhou,1 Di Zhang,1 Hao Li,1 Hongliu Zhang,1 Xin Jiang,1 Ruihua Wang,1 Xi Wang,2 Wenxi Tang1 

1Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu Province, 211198, People’s Republic of China; 2Infection Center, Beijing You’an Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wenxi Tang, Email tokammy@cpu.edu.cn Xi Wang, Email wangxi35@ccmu.edu.cn

Purpose: This study aims to evaluate the economic value of Bictegravir/emtricitabine/tenofovir (B/F/TAF) as a first-line treatment for HIV-1 infection in China, where such evaluations are currently lacking.
Patients and Methods: We developed a monthly-cycle Markov model to evaluate the economics of B/F/TAF versus dolutegravir/lamivudine (DTG/3TC) as a first-line ART for adult HIV-1 patients over a lifelong time. The social costs, quality-adjusted life years (QALYs), incremental net monetary benefit (INMB), and incremental cost-effectiveness ratio (ICER) have been analyzed using health economic methods. Sensitivity analyses were conducted for the result validation. Taking into account the transmissibility of HIV, we have developed a scenario within a dynamic model across the entire population in China, to conduct a health economic evaluation of the two drugs over 30 years. Model precision was tested using relative standard deviation (RSD).
Results: In the Markov model, B/F/TAF had higher per-person costs compared to DTG/3TC ($44,381.33 vs $42,160.13), but also resulted in greater QALYs (11.6771 vs 11.5389), leading to a per-person INMB of $3072.26 (WTP = 3GDP) and an ICER of $16,052.42 per QALY. Uncertainty analyses confirmed the robustness of these results. The dynamic model further indicated that B/F/TAF was both cost-benefit and cost-effective, with a per-person INMB of $7.33 (WTP = 3GDP) and an ICER of $7,953.72 per QALY, although it exhibited a higher RSD.
Conclusion: After adopting the B/F/TAF regimen in China, the cost-benefit and cost-effectiveness of HIV prevention and treatment have significantly improved. We should advocate for B/F/TAF as the first-line treatment to enhance HIV management.

Keywords: HIV, Markov, dynamic model, bictegravir/emtricitabine/tenofovir, China