Cost analysis associated with intramuscular versus oral administration of antiretroviral therapy in the management of human immunodeficiency virus infection

Objetive: To identify and analyze the resources and costs associated with the administration of intramuscular antiretroviral therapy (ART) cabotegravir+rilpivirine (CAB+RPV) compared to oral ART in the management of Human Immunodeficiency Virus Type 1 (HIV-1) infection in Spain.

Methods: An economic model was developed to identify resources and analyze costs from the perspective of the National Health System (NHS) and societal, associated with the administration of intramuscular ART (CAB+RPV) compared to oral ART over a two-year time horizon. Costs included treatment change monitoring, pharmaceutical dispensation, administration, management of adverse events to injection-site reactions (AEs-ISR), travel to the hospital, telepharmacy service, and lost work productivity. Unit costs (€, 2023) were obtained from the literature. Sensitivity analyses were conducted to evaluate the robustness of the model.

Results: Intramuscular ART compared to oral ART was associated with an increase in costs of €673.16/patient over two years from the perspective of the NHS, and €719.59/patient from the social perspective. Intramuscular ART would generate increased costs for dispensation (+€97.75), administration (+€394.55), monitoring (+€288.74), management of AEs-ISR (+€6.46), travel (+€8.36), and lost work productivity (+€38.07), compared to oral ART administration.

Conclusion: Treating HIV-1 with intramuscular CAB+RPV leads to increased resource consumption and costs, compared to oral ART.