L’utilizzo di doravirina per il trattamento dell’infezione da HIV. Un approccio value-based presso un policlinico universitario della Regione Lazio

Introduction. The treatment of HIV infection is constantly evolving due to advances in antiretroviral therapies (ART). Doravirine, a new-generation non-nucleoside reverse transcriptase inhibitor (NNRTI), offers a beneficial therapeutic option for various HIV patient profiles due to its improved tolerability, lower resistance potential, and reduced drug interactions. This analysis aims to assess the value of integrating doravirine-based regimens, considering their economic impact on the hospital organization through a predictive model. Materials and methods. A three-year (2024-2026) comparative predictive model was developed, analyzing three different levels of doravirine implementation and focusing on two formulations available for treatment: doravirine+backbones and a Single Tablet Regimen (STR) consisting of doravirine, 3TC, and TDF. Using the ex-factory drug costs, potential savings compared to standard and alternative therapies were evaluated over the considered time horizon. Results. Doravirine demonstrated the potential to generate significant savings compared to standard therapies for both formulations across all implementation levels, except for the high implementation level for the STR formulation. The benefits, especially for the doravirine+backbones formulation, were shown to be greater in the medium and high implementation scenarios compared to the low implementation scenario. Conclusions. From a value-based strategic model perspective, doravirine represents a promising choice for ART regimens. The analysis suggests that the doravirine+backbones formulation could optimize savings in healthcare resource management while maintaining clinical effectiveness according to available literature data; the STR formulation at low implementation could also be considered in this regard. Further studies are needed to confirm the long-term effectiveness of doravirine, as well as its impact on other costs related to HIV management. However, based on the available evidence, doravirine can be considered a valuable therapy in the context of HIV infection treatment.