- Email: [email protected]
ECONOMIC EVALUATION OF ERTAPENEM IN THE TREATMENT OF SEPSIS FROM ENTEROBACTERIA PRODUCING BETA-LACTAMASES OF EXTENDED SPECTRUM (BLEES) AT THE MEXICO CHILDREN’S HOSPITAL “FEDERICO GOMEZ”
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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
groups (Cef-Met/Im-Cl: BRL 448,391.81/BRL 78,704.94 and Cef-Met/Pi-Tz: BRL 449,206.70/BRL 79,630.37, respectively) due to shorter length of stay and less complications. Conclusions: The cost-effectiveness analysis showed that tigecycline leads to cost-savings in the treatment of IAIs in Brazilian Health Systems and should be considered as a favorable treatment option for these infections. PIN36 ECONOMIC EVALUATION OF ERTAPENEM IN THE TREATMENT OF SEPSIS FROM ENTEROBACTERIA PRODUCING BETA-LACTAMASES OF EXTENDED SPECTRUM (BLEES) AT THE MEXICO CHILDREN’S HOSPITAL “FEDERICO GOMEZ” Reyes-Lopez A 1, Jimenez L 2, Perezbolde C 3, Pastor V 3 Infantil de México, Mexico, Mexico, 2Merck sharp & Dohme, Mexico, Mexico, 3Merck Sharp & Dohme, Mexico Coity, Mexico .
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1Hospital
Objectives: Conduct an cost effectiveness analysis of ertapenem in the treatment of enterobacteria producing beta-lactamases of extended spectrum (BLEES) sepsis at the Mexico Children’s Hospital “Federico Gomez”. Methods: Cost effectiveness analysis from the Children’s Hospital perspective and based in a decision model of static cohorts with the diagnosis of BLEES enterobacterial sepsis. The comparators used were meropenem and imipenem, the time horizon was one year. To model the scenarios associated with the increase percentage of P. aeruginosa resistant to carbapenems, a 2% assumption was made based on the experience and feedback from the hospital’s infectologist for the case in which the use of carbapenems are not changed. These scenarios were compared to a scenario without the increase in the percentage. Treatment costs for carbapenems were calculated in a 10 day scheme for an average weight of 25 kg. Treatment average cost for P. aeruginosa were obtained from patients charts. A univariate deterministic sensitivity analysis with a ±5% variation was performed. Results: Treatment costs were $24,605 MXP, $18,505 MXP and 17,380 MXP for meropenem, imipenem and ertapenem respectively. Ertapenem savings range from $7,225 for meropenem to 1,125 MXP for imipenem. Results from scenarios with increased risk for P. aeruginosa infection at year 2 and 3 resulted in cost of $26,221 and $27,836 MXP for meropenem respectively, $20,121 MXP and $21,736 MXP for imipenem and $17,380 MXP for ertapenem in both years. Mortality rate increase from 3.6% to 5.4% in the meropenem and imipenem groups and stay steady for ertapenem. Conclusions: Ertapenem is a cost-effective and cost-saving alternative for treating enterobacteria producing beta-lactamases of extended spectrum (BLEES) sepsis in the Mexico Children’s Hospital “Federico Gomez”. PIN37 SYSTEMATIC REVIEW OF ECONOMIC EVALUATIONS OF ALTERNATE IMMUNIZATION STRATEGIES TO CONTROL MENINGOCOCCAL MENINGITIS Alvis Zakzuk J 1, Janusz Bess C 2, Alvis Guzman N 3 foundation, Cartagena, Colombia, 2Panamerican Health Organization, Washington DC, DC, USA, 3Universidad de Cartagena. Centro de Investigación y Docencia. Hospital Infantil Napoleón Franco Pareja, Cartagena de Indias, Colombia .
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1Alzak
Objectives: To systematically assess the economic evaluation (EE) literature on immunization strategies used for the control of meningococcal meningitis. Methods: We conducted a systematic review of papers published on meningococcal vaccines (MV) between 1995 and 2015 and retrievable from the PubMed database. The type of EE, MV and/or vaccine strategies being compared; modelling approach; incidence rates, herd effects and costs were extracted and summarized. Drummond 1996 critical appraisal checklist was applied to conduct a quality assessment. Costs and vaccine prices (VP) were converted to international dollars 2013. Results: 146 articles were retrieved and 22 articles were ultimately selected for inclusion in the review. The majority (63%) were cost-effectiveness (CE) studies. Nine types of MV were evaluated in the 22 EE. The majority of countries evaluated Routine vaccination (72%) as a control strategy of the meningococcal disease (MD). As effectiveness outcomes, most of studies (63%) use QALYs. When assessing either the CE of a MV or the CE of the vaccination strategy, 10 studies resulted to be costeffective and 5 resulted to be potentially cost-effective. The remaining studies could not reach the CE threshold because in most cases the vaccine price per dose was not competitive. VP per dose varied significantly by vaccine and by country, ranging from US$0.72 in Senegal (Meningococcal AC polysaccharide vaccine) to US$99 in the USA (quadrivalent conjugated vaccine). Direct and indirect Costs varied significantly in all studies as a result of differing methods. All studies completely meet the 85% of the study design quality criteria. Conclusions: More efforts have to be done in low and lower middle income economies (where IR of MD tend to be higher) to develop quality EE of MV. The development of a methodological costing guide with minimum validity criteria to standardize the methods to be use in future studies of MV its crucial to allow comparability. PIN38 EXPLORING THE COST-EFFECTIVE THRESHOLD PRICE OF DENGUE VACCINATION PROGRAMS IN MALAYSIA: A VALUE-BASED PRICING ASSESSMENT Yeo H Y 1, Shafie A A 1, Coudeville L 2, Steinberg L D 3, Gill B S 4, Jahis R 4 Sains Malaysia, Penang, Malaysia, 2Sanofi Pasteur, Lyon, France, 3Sanofi Pasteur, Petaling Jaya, Malaysia, 4Ministry of Health Malaysia, Wilayah Persekutuan Putrajaya, Malaysia .
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1Universiti
Objectives: Dengue disease poses a huge economic burden in Malaysia. As dengue vaccines get closer to licensure, we aim to estimate the vaccine price at which it can be cost-effective in Malaysia under different vaccination strategies. Methods: We employed a dynamic transmission mathematical model to evaluate the health, economic impact, and the cost-effective threshold price of the vaccine. The model was calibrated with latest phase-III clinical data and Malaysia-specific epidemiological data. The impacts were evaluated over a 10-year period from provider perspective. Two vaccination programs: targeted-hotspots (THS) and nationwide (NW), were simulated. Both programs routinely vaccinated children aged 9 and a catch-up cohort from ages 10 to 17. Probabilistic and univariate sensitivity analyses on key parameters were explored. All costs were expressed in 2013 US$. Results: The model predicted that vaccination under the THS strategy prevented 365,510 [95%CI: 246,706-544,299] dengue cases, 415 [95%CI: 286-608] deaths, and 13,815 [95%CI:
9,547-20,267] DALYs. Nationwide vaccination prevented 858,559 [95%CI: 579,5031,278,503] dengue cases, 976 [95%CI: 671-1,433] deaths, and 32,479 [95%CI: 22,44247,656] DALYs. The total dengue treatment costs saved for THS and NW vaccination programs were US$132,487,470 [95%CI: 88,537,844-201,027,184] and US$311,284,079 [95%CI: 208,024,155-472,320,753] respectively. THS vaccination was cost-effective up to a price of US$71.78 [95%CI: 51.22-99.12] and very cost-effective up to a price of US$34.29 [95%CI: 23.60-48.83]. Nationwide vaccination was cost-effective up to a price of US$28.59 [95%CI: 19.91-40.30] and very cost-effective up to a price of US$12.60 [95%CI: 8.11-18.70]. One-way univariate sensitivity analysis showed that the threshold price was most sensitive to varying the ambulatory reporting factor and least sensitive to the vaccine administration cost and coverage rate for catch-up cohorts. Conclusions: Dengue vaccination significantly reduced the health and economic burden in Malaysia. It is a potentially value for money investment if the purchaser could negotiate a price at or below the cost-effective threshold price for the vaccination programs. PIN39 THE COST EFFECTIVENESS OF TREATMENTS FOR CLOSTRIDIUM DIFFICILE INFECTION: A SYSTEMATIC REVIEW Burton H E 1, Mitchell S A 1, Watt M 2 Europe Ltd, Surrey, UK .
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1DRG, Bicester, UK, 2Astellas
Objectives: Clostridium difficile infection (CDI) can be associated with severe illness and risk of mortality. European clinical guidelines recommend antibiotic treatment with metronidazole, vancomycin, or fidaxomicin. The study objective was to conduct a systematic review to identify studies reporting on the cost-effectiveness of antibiotics recommended for the treatment of CDI. Methods: Three electronic databases (MEDLINE, Embase, and Cochrane Library: accessed October 2015) were searched, and supplementary hand-searching of conference proceedings conducted. Eligible studies reported cost-effectiveness outcomes for fidaxomicin, vancomycin, or metronidazole for the treatment of CDI. Results: Twenty-six economic evaluations, presented in 33 publications, were included. Decision-analytic modelling was reported in 24 studies (decision tree, n= 11; Markov, n= 9; not specified further, n= 4), while two studies reported direct analyses. A payer perspective was reported in 23 studies and results were evaluated for 12 countries across North America and Europe. Reported time horizons ranged from 10 days to lifetime. Fidaxomicin was most frequently compared with vancomycin and was considered cost-effective versus vancomycin or metronidazole in 14/23 (61%) studies. Vancomycin was reported cost-effective versus fidaxomicin or metronidazole in 5/26 (19%) studies; metronidazole was cost-effective versus comparators in 2/12 (17%) studies. Faecal microbiota transplantation was an additional comparator in five analyses. Fifteen studies reported cost-effectiveness outcomes for patient subgroups based on disease severity, risk of CDI recurrence, or whether CDI episodes were primary or recurrent; the majority of these analyses considered fidaxomicin to be costeffective. Key cost drivers were cure rate, recurrence rate, time horizon, and drug costs. Conclusions: There is a large evidence base examining the cost-effectiveness of vancomycin, fidaxomicin, or metronidazole for the treatment of CDI. In the overall population and important subgroups, fidaxomicin was generally reported as cost-effective versus comparators of interest. However, results should be interpreted with caution in light of inter-study heterogeneity, including modelling approaches and payer preferences. PIN40 COST-EFFECTIVENESS OF ATAZANAVIR/RITONAVIR AGAINST LOPINAVIR/ RITONAVIR IN THE TREATMENT OF PEOPLE LIVING WITH HIV IN PERU Bolaños-Díaz R 1, Tejada R A 1, Escobedo-Palza S 2 1Instituto Nacional de Salud, Lima, Peru, 2SPEAS, Lima, Peru .
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Objectives: To compare the cost-effectiveness of atazanavir and boosted ritonavir (ATV/r) against lopinavir and boosted ritonavir (LPV/r), both with tenofovir and emitricitabine (TDF/FTC) backbone in Peru. Methods: We developed a Markov model from the perspective of the Peruvian Ministry of Health, for first and second-line treatment of HIV. We considered a 10 year time horizon, one-year Markov cycles, a 3% discount rate and quality adjusted life years as a measure of effectiveness. Costs were calculated in 2015 Peruvian Soles (S/.) and converted to U.S. Dollars (US$). We calculated an incremental cost-effectiveness ratio (ICER). To assess model uncertainty, we conducted one-way sensitivity analyses to evaluate individual cost drivers and probabilistic sensitivity analysis using Monte Carlo simulations. We considered a willingness to pay (WTP) threshold equal to the annual Peruvian Gross Domestic Product (GDP) per-capita (US$ 6 660). Fianlly, we calculated the net monetary benefit (NMB) considering a WTP range between zero and three times GDP per-capita. We used TreeAge 2015. Results: The deterministic analysis showed that ATV/r is more effective and had higher costs than LPV/r, with an ICER of S/. 38 951 (US$ 11 423) for first-line treatment and S/. 163 660 (US$ 47 994) for second-line treatment. Probabilistic analysis showed that ATV/r would require a WTP greater than annual GDP per-capita in 67.1% and 53.2% of simulations in first and second-line treatment, respectively. The one-way sensitivity analysis found that our model was robust to uncertainty. In first-line treatment, the NMB was higher for LPV/r until two-times GDP per-capita; after this threshold, ATV/r was more cost-effective. In second-line treatment the NMB was higher for LPV/r across WTP ranges. Conclusions: Treatment with TDF/FTC/LPV/r is more cost-effective compared to TDF/FTC/ATV/r, both in naïve and treated patients. Nevertheless, ATV/r could be more cost-effective in first-line treatment if the WTP threshold was set at two-times annual GDP per-capita. PIN41 COST EFFECTIVENESS OF THREE ANTIVIRAL TREATMENTS FOR HEPATITIS C VIRUS CHRONIC INFECTION IN PERU Bolanos-DiazBolaños-Díaz R 1, Tejada R A 1, Sanabria C 2 1Instituto Nacional de Salud, Lima, Peru, 2Universidad Nacional Mayor de San Marcos, Lima, Peru .
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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
groups (Cef-Met/Im-Cl: BRL 448,391.81/BRL 78,704.94 and Cef-Met/Pi-Tz: BRL 449,206.70/BRL 79,630.37, respectively) due to shorter length of stay and less complications. Conclusions: The cost-effectiveness analysis showed that tigecycline leads to cost-savings in the treatment of IAIs in Brazilian Health Systems and should be considered as a favorable treatment option for these infections. PIN36 ECONOMIC EVALUATION OF ERTAPENEM IN THE TREATMENT OF SEPSIS FROM ENTEROBACTERIA PRODUCING BETA-LACTAMASES OF EXTENDED SPECTRUM (BLEES) AT THE MEXICO CHILDREN’S HOSPITAL “FEDERICO GOMEZ” Reyes-Lopez A 1, Jimenez L 2, Perezbolde C 3, Pastor V 3 Infantil de México, Mexico, Mexico, 2Merck sharp & Dohme, Mexico, Mexico, 3Merck Sharp & Dohme, Mexico Coity, Mexico .
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1Hospital
Objectives: Conduct an cost effectiveness analysis of ertapenem in the treatment of enterobacteria producing beta-lactamases of extended spectrum (BLEES) sepsis at the Mexico Children’s Hospital “Federico Gomez”. Methods: Cost effectiveness analysis from the Children’s Hospital perspective and based in a decision model of static cohorts with the diagnosis of BLEES enterobacterial sepsis. The comparators used were meropenem and imipenem, the time horizon was one year. To model the scenarios associated with the increase percentage of P. aeruginosa resistant to carbapenems, a 2% assumption was made based on the experience and feedback from the hospital’s infectologist for the case in which the use of carbapenems are not changed. These scenarios were compared to a scenario without the increase in the percentage. Treatment costs for carbapenems were calculated in a 10 day scheme for an average weight of 25 kg. Treatment average cost for P. aeruginosa were obtained from patients charts. A univariate deterministic sensitivity analysis with a ±5% variation was performed. Results: Treatment costs were $24,605 MXP, $18,505 MXP and 17,380 MXP for meropenem, imipenem and ertapenem respectively. Ertapenem savings range from $7,225 for meropenem to 1,125 MXP for imipenem. Results from scenarios with increased risk for P. aeruginosa infection at year 2 and 3 resulted in cost of $26,221 and $27,836 MXP for meropenem respectively, $20,121 MXP and $21,736 MXP for imipenem and $17,380 MXP for ertapenem in both years. Mortality rate increase from 3.6% to 5.4% in the meropenem and imipenem groups and stay steady for ertapenem. Conclusions: Ertapenem is a cost-effective and cost-saving alternative for treating enterobacteria producing beta-lactamases of extended spectrum (BLEES) sepsis in the Mexico Children’s Hospital “Federico Gomez”. PIN37 SYSTEMATIC REVIEW OF ECONOMIC EVALUATIONS OF ALTERNATE IMMUNIZATION STRATEGIES TO CONTROL MENINGOCOCCAL MENINGITIS Alvis Zakzuk J 1, Janusz Bess C 2, Alvis Guzman N 3 foundation, Cartagena, Colombia, 2Panamerican Health Organization, Washington DC, DC, USA, 3Universidad de Cartagena. Centro de Investigación y Docencia. Hospital Infantil Napoleón Franco Pareja, Cartagena de Indias, Colombia .
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1Alzak
Objectives: To systematically assess the economic evaluation (EE) literature on immunization strategies used for the control of meningococcal meningitis. Methods: We conducted a systematic review of papers published on meningococcal vaccines (MV) between 1995 and 2015 and retrievable from the PubMed database. The type of EE, MV and/or vaccine strategies being compared; modelling approach; incidence rates, herd effects and costs were extracted and summarized. Drummond 1996 critical appraisal checklist was applied to conduct a quality assessment. Costs and vaccine prices (VP) were converted to international dollars 2013. Results: 146 articles were retrieved and 22 articles were ultimately selected for inclusion in the review. The majority (63%) were cost-effectiveness (CE) studies. Nine types of MV were evaluated in the 22 EE. The majority of countries evaluated Routine vaccination (72%) as a control strategy of the meningococcal disease (MD). As effectiveness outcomes, most of studies (63%) use QALYs. When assessing either the CE of a MV or the CE of the vaccination strategy, 10 studies resulted to be costeffective and 5 resulted to be potentially cost-effective. The remaining studies could not reach the CE threshold because in most cases the vaccine price per dose was not competitive. VP per dose varied significantly by vaccine and by country, ranging from US$0.72 in Senegal (Meningococcal AC polysaccharide vaccine) to US$99 in the USA (quadrivalent conjugated vaccine). Direct and indirect Costs varied significantly in all studies as a result of differing methods. All studies completely meet the 85% of the study design quality criteria. Conclusions: More efforts have to be done in low and lower middle income economies (where IR of MD tend to be higher) to develop quality EE of MV. The development of a methodological costing guide with minimum validity criteria to standardize the methods to be use in future studies of MV its crucial to allow comparability. PIN38 EXPLORING THE COST-EFFECTIVE THRESHOLD PRICE OF DENGUE VACCINATION PROGRAMS IN MALAYSIA: A VALUE-BASED PRICING ASSESSMENT Yeo H Y 1, Shafie A A 1, Coudeville L 2, Steinberg L D 3, Gill B S 4, Jahis R 4 Sains Malaysia, Penang, Malaysia, 2Sanofi Pasteur, Lyon, France, 3Sanofi Pasteur, Petaling Jaya, Malaysia, 4Ministry of Health Malaysia, Wilayah Persekutuan Putrajaya, Malaysia .
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1Universiti
Objectives: Dengue disease poses a huge economic burden in Malaysia. As dengue vaccines get closer to licensure, we aim to estimate the vaccine price at which it can be cost-effective in Malaysia under different vaccination strategies. Methods: We employed a dynamic transmission mathematical model to evaluate the health, economic impact, and the cost-effective threshold price of the vaccine. The model was calibrated with latest phase-III clinical data and Malaysia-specific epidemiological data. The impacts were evaluated over a 10-year period from provider perspective. Two vaccination programs: targeted-hotspots (THS) and nationwide (NW), were simulated. Both programs routinely vaccinated children aged 9 and a catch-up cohort from ages 10 to 17. Probabilistic and univariate sensitivity analyses on key parameters were explored. All costs were expressed in 2013 US$. Results: The model predicted that vaccination under the THS strategy prevented 365,510 [95%CI: 246,706-544,299] dengue cases, 415 [95%CI: 286-608] deaths, and 13,815 [95%CI:
9,547-20,267] DALYs. Nationwide vaccination prevented 858,559 [95%CI: 579,5031,278,503] dengue cases, 976 [95%CI: 671-1,433] deaths, and 32,479 [95%CI: 22,44247,656] DALYs. The total dengue treatment costs saved for THS and NW vaccination programs were US$132,487,470 [95%CI: 88,537,844-201,027,184] and US$311,284,079 [95%CI: 208,024,155-472,320,753] respectively. THS vaccination was cost-effective up to a price of US$71.78 [95%CI: 51.22-99.12] and very cost-effective up to a price of US$34.29 [95%CI: 23.60-48.83]. Nationwide vaccination was cost-effective up to a price of US$28.59 [95%CI: 19.91-40.30] and very cost-effective up to a price of US$12.60 [95%CI: 8.11-18.70]. One-way univariate sensitivity analysis showed that the threshold price was most sensitive to varying the ambulatory reporting factor and least sensitive to the vaccine administration cost and coverage rate for catch-up cohorts. Conclusions: Dengue vaccination significantly reduced the health and economic burden in Malaysia. It is a potentially value for money investment if the purchaser could negotiate a price at or below the cost-effective threshold price for the vaccination programs. PIN39 THE COST EFFECTIVENESS OF TREATMENTS FOR CLOSTRIDIUM DIFFICILE INFECTION: A SYSTEMATIC REVIEW Burton H E 1, Mitchell S A 1, Watt M 2 Europe Ltd, Surrey, UK .
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1DRG, Bicester, UK, 2Astellas
Objectives: Clostridium difficile infection (CDI) can be associated with severe illness and risk of mortality. European clinical guidelines recommend antibiotic treatment with metronidazole, vancomycin, or fidaxomicin. The study objective was to conduct a systematic review to identify studies reporting on the cost-effectiveness of antibiotics recommended for the treatment of CDI. Methods: Three electronic databases (MEDLINE, Embase, and Cochrane Library: accessed October 2015) were searched, and supplementary hand-searching of conference proceedings conducted. Eligible studies reported cost-effectiveness outcomes for fidaxomicin, vancomycin, or metronidazole for the treatment of CDI. Results: Twenty-six economic evaluations, presented in 33 publications, were included. Decision-analytic modelling was reported in 24 studies (decision tree, n= 11; Markov, n= 9; not specified further, n= 4), while two studies reported direct analyses. A payer perspective was reported in 23 studies and results were evaluated for 12 countries across North America and Europe. Reported time horizons ranged from 10 days to lifetime. Fidaxomicin was most frequently compared with vancomycin and was considered cost-effective versus vancomycin or metronidazole in 14/23 (61%) studies. Vancomycin was reported cost-effective versus fidaxomicin or metronidazole in 5/26 (19%) studies; metronidazole was cost-effective versus comparators in 2/12 (17%) studies. Faecal microbiota transplantation was an additional comparator in five analyses. Fifteen studies reported cost-effectiveness outcomes for patient subgroups based on disease severity, risk of CDI recurrence, or whether CDI episodes were primary or recurrent; the majority of these analyses considered fidaxomicin to be costeffective. Key cost drivers were cure rate, recurrence rate, time horizon, and drug costs. Conclusions: There is a large evidence base examining the cost-effectiveness of vancomycin, fidaxomicin, or metronidazole for the treatment of CDI. In the overall population and important subgroups, fidaxomicin was generally reported as cost-effective versus comparators of interest. However, results should be interpreted with caution in light of inter-study heterogeneity, including modelling approaches and payer preferences. PIN40 COST-EFFECTIVENESS OF ATAZANAVIR/RITONAVIR AGAINST LOPINAVIR/ RITONAVIR IN THE TREATMENT OF PEOPLE LIVING WITH HIV IN PERU Bolaños-Díaz R 1, Tejada R A 1, Escobedo-Palza S 2 1Instituto Nacional de Salud, Lima, Peru, 2SPEAS, Lima, Peru .
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Objectives: To compare the cost-effectiveness of atazanavir and boosted ritonavir (ATV/r) against lopinavir and boosted ritonavir (LPV/r), both with tenofovir and emitricitabine (TDF/FTC) backbone in Peru. Methods: We developed a Markov model from the perspective of the Peruvian Ministry of Health, for first and second-line treatment of HIV. We considered a 10 year time horizon, one-year Markov cycles, a 3% discount rate and quality adjusted life years as a measure of effectiveness. Costs were calculated in 2015 Peruvian Soles (S/.) and converted to U.S. Dollars (US$). We calculated an incremental cost-effectiveness ratio (ICER). To assess model uncertainty, we conducted one-way sensitivity analyses to evaluate individual cost drivers and probabilistic sensitivity analysis using Monte Carlo simulations. We considered a willingness to pay (WTP) threshold equal to the annual Peruvian Gross Domestic Product (GDP) per-capita (US$ 6 660). Fianlly, we calculated the net monetary benefit (NMB) considering a WTP range between zero and three times GDP per-capita. We used TreeAge 2015. Results: The deterministic analysis showed that ATV/r is more effective and had higher costs than LPV/r, with an ICER of S/. 38 951 (US$ 11 423) for first-line treatment and S/. 163 660 (US$ 47 994) for second-line treatment. Probabilistic analysis showed that ATV/r would require a WTP greater than annual GDP per-capita in 67.1% and 53.2% of simulations in first and second-line treatment, respectively. The one-way sensitivity analysis found that our model was robust to uncertainty. In first-line treatment, the NMB was higher for LPV/r until two-times GDP per-capita; after this threshold, ATV/r was more cost-effective. In second-line treatment the NMB was higher for LPV/r across WTP ranges. Conclusions: Treatment with TDF/FTC/LPV/r is more cost-effective compared to TDF/FTC/ATV/r, both in naïve and treated patients. Nevertheless, ATV/r could be more cost-effective in first-line treatment if the WTP threshold was set at two-times annual GDP per-capita. PIN41 COST EFFECTIVENESS OF THREE ANTIVIRAL TREATMENTS FOR HEPATITIS C VIRUS CHRONIC INFECTION IN PERU Bolanos-DiazBolaños-Díaz R 1, Tejada R A 1, Sanabria C 2 1Instituto Nacional de Salud, Lima, Peru, 2Universidad Nacional Mayor de San Marcos, Lima, Peru .
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