De-simplifying single-tablet antiretroviral treatments: uptake, risks and cost savings

Autor: S Campbell, M Lahl, Michael Gill, Hartmut B. Krentz
Rok vydání: 2018
Předmět:
0301 basic medicine
Adult
Male
medicine.medical_specialty
Canada
Pyridones
HIV Infections
Comorbidity
Piperazines
Men who have sex with men
03 medical and health sciences
0302 clinical medicine
Patient satisfaction
Acquired immunodeficiency syndrome (AIDS)
Abacavir
Cost Savings
Health care
Oxazines
medicine
Drugs
Generic
Humans
Pharmacology (medical)
030212 general & internal medicine
Homosexuality
Male
Adverse effect
health care economics and organizations
Aged
Health economics
business.industry
Health Policy
Age Factors
Lamivudine
Middle Aged
Patient Acceptance of Health Care
medicine.disease
030112 virology
Dideoxynucleosides
Drug Combinations
Infectious Diseases
Treatment Outcome
Anti-Retroviral Agents
Patient Satisfaction
Emergency medicine
Female
business
Heterocyclic Compounds
3-Ring
medicine.drug
Tablets
Zdroj: HIV medicine. 20(3)
ISSN: 1468-1293
Popis: Objectives As more HIV-positive individuals receive antiretroviral therapy (ART), payers are seeking options for covering these increased and sustained drug costs. Strategic use of available generic antiretroviral (ARV) formulations may be feasible. De-simplifying a single-tablet co-formulation (STF) into two or more tablets using both brand and generic drugs has been proposed. We determine if voluntary de-simplification of one STF could be utilized as a cost-saving strategy. We report on the challenges, uptake, outcomes and cost savings of this initiative. Methods Patients stable on the most commonly used STF (Triumeq® ) were offered the option of remaining on Triumeq® or switching to generic abacavir/lamivudine and Tivicay® between 1 January 2015 and 1 January 2018; those starting ART consisting of abacavir/lamivudine/doulutegravir in the same period were offered the option of starting Triumeq® or generic abacavir/laminvudine and Tivicay® . No incentives were provided. We examined the acceptance/decline rates, patient satisfaction, health care outcomes and annual cost savings. Results Of 626 patients receiving Triumeq® , 321 were approached; 177 (55.1%) agreed to de-simplify. Of patients initiating ART, 62.7% chose the generic co-formulation. Patients switching to or starting on the generic co-formulation were more likely to be male, > 45 years old, Caucasian, men who have sex with men (MSM) and more HIV-experienced, and to have more comorbidities (all P 500 HIV-1 RNA copies/mL after baseline was 2.7% in switched patients compared with 7.0% in those declining to switch. No de novo resistance occurred. A saving of Cdn$1 319 686 was achieved in the first year. Conclusions Reliance on altruism, while respecting patient autonomy, achieved de-simplification in > 50% of patients approached, and generated immediate cost savings with no increased risk of adverse events, viral breakthrough or resistance.
Databáze: OpenAIRE
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