The Epidemic | 01.2016


Two-Drug Combination Savings

Two-drug ART with dolutegravir-lamivudine more cost-effective.

Virologically suppressive first-line antiretroviral treatment with a two-drug regimen of dolutegravir (Tivicay) and lamivudine would be highly cost effective and could save US health systems approximately $500 million over five years, according to the results of a mathematical model published in the online edition of Clinical Infectious Diseases, reports

Switching a quarter of currently suppressed patients to the two-drug combination could achieve five-year savings of $3 billion.

“We demonstrate that an induction-maintenance strategy of three-drug initial therapy with DTG/ABC/3TC [dolutegravir/abacavir/lamivudine] followed by DTG+3TC maintenance would be cost-effective in the US under plausible virologic efficacy assumptions; DTG+3TC as initial therapy could be even more cost effective,” comment the researchers. “We find that the induction-maintenance and two-drug strategies, if adopted, could save over $500 million or $800 million, respectively, in HIV therapy costs in the first five years compared to the current standard of care.”

The study’s findings are described as “important” by the authors of an accompanying editorial, who suggest that cost savings achieved with effective two-drug therapy could be used to improve rates of engagement and retention in care, both key to controlling the HIV epidemic in the US.

First-line HIV therapy normally consists of three drugs from two separate antiretroviral classes. This treatment usually costs upwards of $30,000 per patient, per year.

Results of a pilot study presented to the 15th European AIDS Conference this year showed that first-line treatment with two just two drugs—the potent integrase inhibitor dolutegravir with lamivudine—had excellent virological efficacy over 48 weeks, with a favorable safely/toxicity profile. Full results will be published in 2016.