OBJECTIVES: To evaluate the cost-saving of a co-formulated tablet of Efavirenz 400 mg with Lamivudine and Tenofovir disoproxil fumarate (EFV400/3TC/TDF) as an antiretroviral treatment (ART) for HIV-1 infections in adults, compared to other ARTs used in the Mexican public health system.

METHODS: A systematic review (SR) and a network meta-analysis (NMA) were performed to evaluate the efficacy and safety of EFV400/3TC/TDF and its comparators for the treatment of HIV‑1 infection in adults. The comparators included bictegravir+emtricitabine(FTC)+tenofovir alafenamide (TAF), dolutegravir(DTG)+abacavir+3TC, DTG+FTC+TAF, DTG+((FTC+TAF) or (FTC or 3TC [XTC]+tenofovir disoproxil [TDx]])), DTG+3TC, doravirine+TDx+3TC, efavirenz(EFV)+TDx, darunavir+cobicistat+ ((TAF+FTC) or (TDx+FTC or 3TC)), doravirine+((TAF+FTC) or (TDx+FTC or 3TC)), EFV+((TAF+FTC) or (TDx+XTC)), raltegravir+((TAF+FTC) o (TDx+FTC or 3TC)), darunavir+cobicistat+ 3TC. Since no significant differences in efficacy or safety were found, a one-year cost-minimization analysis was conducted focused on direct medical costs. A five-year (2024-2028) budget impact analysis evaluated the economic impact of EFV400/3TC/TDF as a treatment option.

RESULTS: The SR included 18 RTCs, with efficacy data (viral suppression <50 copies/mL of HIV-1 ARN) and safety data (serious adverse events) for EFV400/3TC/TDF and its comparators. Results showed no statistically significant differences in efficacy or safety between EFV400/3TC/TDF and the compared treatments. EFV400/3TC/TDF saves an average of 1,461.75 EUR per patient, equivalent to a 75.1% savings over one year compared to all available options. The impact on the National Health System budget of introducing EFV400/3TC/TDF over a 5-year period generates an average annual savings of 21,998,187.98 EUR, which represents 0.314% of the budget.

CONCLUSIONS: EFV400/3TC/TDF shows no statistically significant differences in viral suppression and safety. It is a cost-saving option with savings of up to 75.1% compared to some of its competitors, making it a valuable option for the National Health System in Mexico for treating HIV-1 infection in adult patients.