Cost-effectiveness of long-acting injectable cabotegravir-rilpivirine as HIV treatment per virally-suppressed persons in a San Francisco clinic: an intermediary outcome analysis.

Abstract

Background: Long-acting injectable cabotegravir-rilpivirine (CAB/RPV-LA) is a promising treatment alternative for people with HIV (PWH) who face adherence challenges with oral antiretroviral therapy (ART). While its clinical efficacy is well-documented, cost-effectiveness data from real-world settings remain limited.

Objective: To evaluate the incremental first-year cost and cost-effectiveness of CAB/RPV-LA versus standard of care (SoC) oral ART among PWH with adherence challenges, from the perspective of a healthcare payer.

Methods: A cohort of 59 PWH initiating CAB/RPV-LA at Ward 86, a San Francisco-based clinic, was analyzed. Viral suppression (VS) rates and treatment costs were compared between CAB/RPV-LA and SoC ART. Cost-effectiveness was assessed using incremental cost per newly virally-suppressed PWH and net monetary benefit (NMB). Sensitivity analyses were performed to evaluate parameter uncertainty.

Results: CAB/RPV-LA achieved a VS rate of 92%, compared to an estimated 15% with SoC ART. The estimated first-year cost of CAB/RPV-LA delivery was $67,041 per patient versus $50,668 for SoC. The incremental cost per newly virally-suppressed PWH was $21,264. CAB/RPV-LA is the most cost-effective option at any willingness-to-pay above this level. The NMB was $243,721 suggesting favorable cost-effectiveness. Sensitivity analyses confirmed the robustness of these results.

Conclusions: Initiating CAB/RPV-LA for PWH with viremia suggests highly favorable cost-effectiveness. Results are sensitive to the costs of antiretroviral drugs, but not to variations in personnel costs or rates of viral suppression within plausible input ranges.