August 28, 2013
Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.
The recently approved once-daily integrase inhibitor dolutegravir is now in pharmacies and, like every new HIV drug, the price -- around $14k/year -- has generated some controversy.
For the record, here are the per-year wholesale acquisition costs of the three FDA-approved integrase inhibitors.
If you add the $12 or 15K for the ABC/3TC or TDF/FTC respectively, you get the total cost of initial therapy. So these integrase-based regimens cost more than TDF/FTC/EFV (22.5K) or TDF/FTC/RPV (23.2K), and less than boosted atazanavir- or darunavir-based regimens, which are around 30k.
Now obviously these are all big numbers -- HIV treatment is expensive -- but the flip side is that it's so staggeringly effective that it generally meets acceptable criteria for cost-effectiveness given the huge added years of life.
But incremental cost-effectiveness is another matter -- meaning, is the additional cost of one drug over another justified, and/or good value?
Here, then, are two opposite perspectives on the dolutegravir pricing:
Is dolutegravir fairly priced?
[Editor's note: You can vote on this poll and view results by visiting the original blog post.]
Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.