OBJECTIVES: To estimate the cost-utility of bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) versus other triple combination antiretroviral therapies for naive patients over 18 years of age living with Human Immunodeficiency Virus type 1 (HIV-1) infection, without current or previous resistance to integrase strand transfer inhibitors, TAF or FTC, from the Colombian’s health system perspective.

METHODS: A cost-utility analysis was developed following local methodological manual. A Markov model with a time horizon equivalent to life expectancy was adapted. Direct medical costs were estimated including medications, procedures, laboratory tests for antiretroviral treatment, disease management, comorbidities, and adverse events. The sources of the costs were SISMED, list of regulated prices of medicines and ISS tariff manual. An infectologist expert in HIV validated the PICOT question, the model, and the use of resources. The epidemiological and clinical parameters of the model were obtained from systematic reviews, meta-analyses, clinical studies, High-Cost Account, and expert opinion; health utilities and disutilities were extracted from the scientific literature. The health outcome was Quality Adjusted Life Years (QALYs). A discount rate of 5% was applied for costs and outcomes. A willingness-to-pay threshold of COP 59,448,205/QALY (three GDP per capita of Colombia, 2021) was used, and a probabilistic sensitivity analysis was performed.

RESULTS: In the base case, BIC/TAF/FTC with an average expected value per patient of COP 378,836,272/12.01 QALYs, presents strict dominance versus DTG/ABC/3TC, DTG/TDF/FTC, RAL/TAF/FTC, RAL/TDF/FTC, RAL+ABC/3TC, EVG/c/TDF/FTC, DOR/TDF/3TC and DRV/r+ABC/3TC. BIC/TAF/FTC is cost-effective compared to DTG/TAF/FTC and EVG/c/TAF/FTC with an incremental cost-effectiveness ratios of COP 25,423,858/QALY and COP 46,848,852/QALY, respectively. In the sensitivity analysis, BIC/TAF/FTC versus all the alternatives evaluated has an average probability of being cost-effective/dominant of 90.5%.

CONCLUSIONS: In naive patients over 18 years of age living with HIV-1 infection, BIC/TAF/FTC versus other triple combination antiretroviral therapies is a cost-effective technology for the Colombian health system.