{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:54Z","timestamp":1792787274430,"version":"4.5.0"},"reference-count":39,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"of Medicine in Shenzhen","award":["SZSM202111001"],"award-info":[{"award-number":["SZSM202111001"]}]},{"name":"Incubation Fund of Vanke School of Public Health at Tsinghua University","award":["2021PY002"],"award-info":[{"award-number":["2021PY002"]}],"id":[{"id":"https:\/\/ror.org\/03cve4549","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Jiangsu Aidea Pharmaceutical Co., Ltd"},{"name":"National Key R&D Program of China","award":["2021ZD0114102"],"award-info":[{"award-number":["2021ZD0114102"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,21]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ainuovirine (ANV), a new non-nucleoside reverse transcriptase inhibitor, has been shown to have comparable effectiveness to efavirenz (EFV) with fewer adverse events. However, evidence on the cost-effectiveness of replacing EFV-based regimens with ANV-based regimens remains limited, particularly within the context of China\u2019s National Free Antiretroviral Treatment Programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the cost-effectiveness of ANV-based versus EFV-based regimens among people living with HIV (PLWH) in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Decision tree-Markov models were developed to compare EFV-based and ANV-based regimens over a 15-year time horizon from a societal perspective. Model inputs, including treatment costs and adverse event risks, were mainly obtained from a multicentre Chinese cohort and field survey data. Cost-effectiveness was assessed separately for treatment-na\u00efve and treatment-experienced populations and at the overall programme level. Outcomes included costs, quality-adjusted life-years (QALYs), adverse events and incremental cost-effectiveness ratios (ICERs). One-way, probabilistic and scenario sensitivity analyses were conducted to assess parameter and structural uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with the EFV-based regimen, ANV-based regimen was associated with a marked reduction in cumulative adverse events, while producing small per-person QALY gains of 0.006\u20130.011 at modestly higher costs across the modelled populations. ANV-based regimens generated slightly higher QALYs at modestly higher costs across all modelled populations. The ICERs were $10 030.41\/QALY in treatment-na\u00efve individuals, $3881.06\/QALY in treatment-experienced individuals and $5146.18\/QALY at the overall programme level, all below the prespecified willingness-to-pay threshold of three times China\u2019s 2019 per-capita gross domestic product ($30 793.15\/QALY). Sensitivity analyses showed that the results were robust, with ANV and EFV medication costs being the most influential parameters. If the half-year cost of ANV medication decreased below $361.39, the ANV-based regimen would become the dominant strategy, providing greater health benefits at lower overall costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Within the context of China\u2019s National Free Antiretroviral Treatment Programme, ANV-based regimens were cost-effective compared with EFV-based regimens among PLWH, with reduced adverse events and modest QALY gains at acceptable incremental costs. These findings support consideration of ANV-based regimens as an alternative option in future procurement and price negotiation decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120914","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:30:19Z","timestamp":1789738219000},"page":"e120914","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness analysis of efavirenz versus ainuovirine in people living with HIV initiating first-line combination antiretroviral therapy"],"prefix":"10.1136","volume":"16","author":[{"given":"Chenlu","family":"Yang","sequence":"first","affiliation":[{"name":"Vanke School of Public Health, Tsinghua Univerisity, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2382-1189","authenticated-orcid":false,"given":"Yuanqi","family":"Mi","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhong","family":"Zeng","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Sichuan Provincial People\u2019s Hospital, University of Electronic Science and Technology of China, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5599-460X","authenticated-orcid":false,"given":"Feng","family":"Cheng","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua Univerisity, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huatang","family":"Zeng","sequence":"additional","affiliation":[{"name":"Shenzhen Health Development Research and Data Management Center, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengge","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences; School of Basic Medicine Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"2026091806301171000_16.9.e120914.1","unstructured":"World Health Organization . HIV and AIDS. 2023. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hiv-aids [Accessed 08 Nov 2023]."},{"key":"2026091806301171000_16.9.e120914.2","unstructured":"World Health Organization . HIV country profile 2023. 2023. Available: https:\/\/cfs.hivci.org\/index.html [Accessed 26 Jun 2024]."},{"key":"2026091806301171000_16.9.e120914.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199808063390612"},{"key":"2026091806301171000_16.9.e120914.4","first-page":"1106","article-title":"[Chinese guidelines for diagnosis and treatment of HIV\/AIDS (2021 edition)]","volume":"60","year":"2021","journal-title":"Zhonghua Nei Ke Za Zhi"},{"key":"2026091806301171000_16.9.e120914.5","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s11904-019-00478-x","article-title":"Optimizing Treatment for Adults with HIV\/AIDS in China: Successes over Two Decades and Remaining Challenges","volume":"17","author":"Cao","year":"2020","journal-title":"Curr HIV\/AIDS Rep"},{"key":"2026091806301171000_16.9.e120914.6","doi-asserted-by":"crossref","DOI":"10.3390\/biom13010088","article-title":"Efavirenz: History, Development and Future","volume":"13","author":"Costa","year":"2022","journal-title":"Biomolecules"},{"key":"2026091806301171000_16.9.e120914.7","article-title":"Efficacy and safety of ainuovirine versus efavirenz combination therapies with lamivudine\/tenofovir disoproxil fumarate for medication of treatment-na\u00efve HIV-1-positive adults: week 48 results of a randomized controlled phase 3 clinical trial followed by an open-label setting until week 96","volume":"36","author":"Su","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"2026091806301171000_16.9.e120914.8","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001573"},{"key":"2026091806301171000_16.9.e120914.9","first-page":"430","article-title":"Drug-Induced Liver Injury in HIV Patients","volume":"2","author":"Neff","year":"2006","journal-title":"Gastroenterol Hepatol (N Y)"},{"key":"2026091806301171000_16.9.e120914.10","first-page":"661","article-title":"[Chinese expert consensus on integrated lipid management in HIV\/AIDS]","volume":"62","year":"2023","journal-title":"Zhonghua Nei Ke Za Zhi"},{"key":"2026091806301171000_16.9.e120914.11","doi-asserted-by":"crossref","first-page":"559","DOI":"10.2174\/1389200218666171108154419","article-title":"Drug-Induced Nephrotoxicity: Pathogenic Mechanisms, Biomarkers and Prevention Strategies","volume":"19","author":"Wu","year":"2018","journal-title":"Curr Drug Metab"},{"key":"2026091806301171000_16.9.e120914.12","unstructured":"Laposata M . Clinical laboratory reference values. In: Laboratory medicine: the diagnosis of disease in the clinical laboratory. New York, NY: McGraw-Hill Education, 2014."},{"key":"2026091806301171000_16.9.e120914.13","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.131"},{"key":"2026091806301171000_16.9.e120914.14","unstructured":"American Board of Internal Medicine . Laboratory tests reference ranges. ABIM; 2024.1\u201312."},{"key":"2026091806301171000_16.9.e120914.15","unstructured":"World Health Organization . The role of HIV viral suppression in improving individual health and reducing transmission: policy brief. Geneva: World Health Organization, 2013:13."},{"key":"2026091806301171000_16.9.e120914.16","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofab562","article-title":"Characterization of Heavily Treatment-Experienced People With HIV and Impact on Health Care Resource Utilization in US Commercial and Medicare Advantage Health Plans","volume":"8","author":"Priest","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2026091806301171000_16.9.e120914.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0171780","article-title":"High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015","volume":"12","author":"Kyaw","year":"2017","journal-title":"PLoS One"},{"key":"2026091806301171000_16.9.e120914.18","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/S2352-3018(15)00087-9","article-title":"Monitoring and switching of first-line antiretroviral therapy in adult treatment cohorts in sub-Saharan Africa: collaborative analysis","volume":"2","author":"Haas","year":"2015","journal-title":"Lancet HIV"},{"key":"2026091806301171000_16.9.e120914.19","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/hiv.13006","article-title":"Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific","volume":"22","author":"Ross","year":"2021","journal-title":"HIV Med"},{"key":"2026091806301171000_16.9.e120914.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0225631","article-title":"Genotyping and outcomes of presumptive second line ART failure cases switched to third line or maintained on second line ART in Mumbai, India","volume":"14","author":"Gill","year":"2019","journal-title":"PLoS One"},{"key":"2026091806301171000_16.9.e120914.21","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001883"},{"key":"2026091806301171000_16.9.e120914.22","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32835cae9c"},{"key":"2026091806301171000_16.9.e120914.23","doi-asserted-by":"crossref","DOI":"10.1186\/1742-4690-7-46","article-title":"Undetectable plasma viral load predicts normal survival in HIV-2-infected people in a West African village","volume":"7","author":"van der Loeff","year":"2010","journal-title":"Retrovirology"},{"key":"2026091806301171000_16.9.e120914.24","unstructured":"National Bureau of Statistics of China . China statistical yearbook (2019). Peking: China Statistics Press, 2019."},{"key":"2026091806301171000_16.9.e120914.25","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283360976"},{"key":"2026091806301171000_16.9.e120914.26","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000166"},{"key":"2026091806301171000_16.9.e120914.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2008.00326.x"},{"key":"2026091806301171000_16.9.e120914.28","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.17.4.19605","article-title":"Cost-effectiveness of DTG+ABC\/3TC versus EFV\/TDF\/FTC for first-line treatment of HIV-1 in the United States","volume":"17","author":"Peng","year":"2014","journal-title":"J Int AIDS Soc"},{"key":"2026091806301171000_16.9.e120914.29","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s40121-015-0071-0","article-title":"Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Naive and Treatment-Experienced Patients in Canada","volume":"4","author":"Despi\u00e9gel","year":"2015","journal-title":"Infect Dis Ther"},{"key":"2026091806301171000_16.9.e120914.30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003389","article-title":"Health information technology interventions and engagement in HIV care and achievement of viral suppression in publicly funded settings in the US: A cost-effectiveness analysis","volume":"18","author":"Shade","year":"2021","journal-title":"PLoS Med"},{"key":"2026091806301171000_16.9.e120914.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-17052-1","article-title":"Cost-effectiveness analysis of antiretroviral drugs for treatment-naive HIV infection in China","volume":"23","author":"Li","year":"2023","journal-title":"BMC Public Health"},{"key":"2026091806301171000_16.9.e120914.32","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.2147\/DDDT.S65596","article-title":"Pharmacokinetics and tolerability of the new second-generation nonnucleoside reverse- transcriptase inhibitor KM-023 in healthy subjects","volume":"8","author":"Cha","year":"2014","journal-title":"Drug Des Devel Ther"},{"key":"2026091806301171000_16.9.e120914.33","doi-asserted-by":"crossref","first-page":"332","DOI":"10.2174\/1570162X18666200620211922","article-title":"The New NNRTI ACC007 Combined with Lamivudine and Tenofovir Disoproxil Fumarate Show Synergy Anti-HIV Activity In Vitro","volume":"18","author":"Huang","year":"2020","journal-title":"Curr HIV Res"},{"key":"2026091806301171000_16.9.e120914.34","doi-asserted-by":"crossref","first-page":"176","DOI":"10.5582\/bst.2024.01070","article-title":"Efficacy and effect on lipid profiles of Ainuovirine-based regimen versus Efavirenz-based regimen in treatment-na\u00efve people with HIV-1 at week 24: A real-world, retrospective, multi-center cohort study","volume":"18","author":"Long","year":"2024","journal-title":"Biosci Trends"},{"key":"2026091806301171000_16.9.e120914.35","doi-asserted-by":"crossref","DOI":"10.1186\/1743-422X-10-261","article-title":"Liver steatosis in Chinese HIV-infected patients with hypertriglyceridemia: characteristics and independent risk factors","volume":"10","author":"Xiao","year":"2013","journal-title":"Virol J"},{"key":"2026091806301171000_16.9.e120914.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2020.06.005"},{"key":"2026091806301171000_16.9.e120914.37","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2017.31"},{"key":"2026091806301171000_16.9.e120914.38","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-017-2626-z","article-title":"Cardiovascular risk and dyslipidemia among persons living with HIV: a review","volume":"17","author":"Maggi","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2026091806301171000_16.9.e120914.39","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1089\/aid.2012.0210","article-title":"Outcomes of second combination antiretroviral therapy regimens among HIV-infected persons in clinical care: a multicenter cohort study","volume":"29","author":"Napravnik","year":"2013","journal-title":"AIDS Res Hum Retroviruses"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-120914","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:30:28Z","timestamp":1789738228000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-120914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":39,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,18]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjopen-2026-120914"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-120914","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}