OBJECTIVES: The aim of the work was to economically evaluate the existing ART practice and to model the consequences of new recommendations in the HIV treatment with the expansion of genotyping and dolutegravir use based on the developed local epidemiological data model.

METHODS: The methodology included two stages: statistical processing of epidemiological data from the patient database (1,113 HIV patients receiving ART, based on the Center for AIDS Prevention and Control records for 2011-2016), and development of a mathematical model, that allows to evaluate the economic aspects of various therapeutic approaches implementation. Modeling included the following scenarios: #1: Implementation of dolutegravir and recommendations; #2: Genotyping at the 1st scheme without changing the ART; #3: Genotyping and recommendations - the use of dolutegravir at a resistance level of 5.3%; #4: Genotyping and recommendations - the use of dolutegravir in 50% of cases. Model input parameters: distribution of therapeutic approaches in accordance with the simulated scenarios, the cost of ART and routine genotyping.

RESULTS: During the estimated period, the cost of 80% of the prescribed regimens was less than 37,000 rubles. Each subsequent treatment regimen was 5-10% more expensive than the previous one. Each patient had 2 to 13 treatment changes. The volume of genotyping regardless of therapy stage did not exceed 10%. The most commonly prescribed ARTs were zidovudine, lamivudine, efavirenz, nevirapine, ritonavir-lopinavir. The costs of the considered ART approaches amounted to 848,979,644 rubles. When simulating the planned scenarios, there was a tendency to slightly reduce or increase the costs (within 10%).

CONCLUSIONS: The introduction of routine genotyping for a personalized approach to the selection of ART regimen allows to reduce the cost of managing HIV-infected patients due to a decrease in the number of therapy changes. The increased use of dolutegravir in the first line of HIV therapy increases the cost of ART up to 10%.