Adherence to combined Lamivudine+Zidovudine versus individual components: A community-based retrospective medicaid claims analysis

Legorreta, Antonio P.; A, Yu; Chernicoff, Helen O.; Gilmore, Amanda; Jordan, Jamie C.; Jc, Rosenzweig

doi:10.1080/09540120500100692

Cited by 29 publications

(21 citation statements)

References 34 publications

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“…At the therapeutic level, combining AH and LL agents into a single pill offers a simple and potentially useful means of improving treatment adherence, by synchronizing therapy initiation, reducing pill burden, and also reducing the co-payment for an additional prescription, shown to adversely affect adherence. 30,31 Combination therapies targeting single risk factors, including hypertension and diabetes, have previously been associated with adherence benefits, [32][33][34] and patients have been reported to prefer a single-pill combination tablet to a 2-pill regimen. 35,36 The recent Caduet Adherence Research Program and Education-Pharmacy Benefits Manager (PBM) adherence study assessed adherence to a single-pill combination of the AH calcium channel blocker, amlodipine besylate, and the LL agent, atorvastatin calcium, in comparison with the parent compounds and other calcium channel blockers and statins taken separately.…”

Section: Discussionmentioning

confidence: 98%

Does Synchronizing Initiation of Therapy Affect Adherence to Concomitant Use of Antihypertensive and Lipid-Lowering Therapy?

Agarwal¹,

Tang

Rosenberg

et al. 2009

American Journal of Therapeutics

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Although efficacious medications are available to treat hypertension and dyslipidemia, treatment adherence is often poor. This retrospective study evaluated adherence in patients newly initiating antihypertensive (AH) and lipid-lowering (LL) therapies simultaneously versus within 180 days of one another. Data were analyzed for US managed care plan enrollees initiating AH before LL (cohort 1;n = 7099), LL before AH (cohort 2; n = 3229), or AH/LL simultaneously (cohort 3; n = 5072). A multivariate model evaluated potential predictors of adherence (medication possession ratio >or= 0.80 over a bimonthly period). Percentages of patients adherent to AH/LL at 2, 6, and 12 months were as follows: 59.4%, 32.7%, and 31.3% in cohort 1; 45.0%, 30.8%, and 31.0% in cohort 2; and 75.2%, 34.4%, and 34.0% in cohort 3, respectively. After adjustment for potential confounders, patients initiating AH before LL therapy, or LL before AH therapy, were less likely to be adherent than patients prescribed both agents simultaneously (odds ratios = 0.838 and 0.691, respectively; P , 0.0001). Synchronous initiation of AH and LL therapies is an important predictor of adherence.

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Section: Discussionmentioning

confidence: 98%

Does Synchronizing Initiation of Therapy Affect Adherence to Concomitant Use of Antihypertensive and Lipid-Lowering Therapy?

Agarwal¹,

Tang

Rosenberg

et al. 2009

American Journal of Therapeutics

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“…For example, the 600 mg single-pill dosing of efavirenz is more convenient than the former 200 mg formulation and is US$120 cheaper PPPY. Similarly, the generic AZT/3TC fixed-dose combination is expected to enhance patient adherence to HAART by reducing pill volume [58–60]. At a price of US$17,301 PPPY, Roche/Trimeris' injectable entry inhibitor enfuvirtide is perhaps the most controversial drug in Brazil's treatment guidelines, but presents options for salvage therapy in highly treatment-experienced AIDS patients for whom other treatment options have failed [57].…”

Section: Discussionmentioning

confidence: 99%

Evolution of Antiretroviral Drug Costs in Brazil in the Context of Free and Universal Access to AIDS Treatment

Nunn¹,

et al. 2007

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BackgroundLittle is known about the long-term drug costs associated with treating AIDS in developing countries. Brazil's AIDS treatment program has been cited widely as the developing world's largest and most successful AIDS treatment program. The program guarantees free access to highly active antiretroviral therapy (HAART) for all people living with HIV/AIDS in need of treatment. Brazil produces non-patented generic antiretroviral drugs (ARVs), procures many patented ARVs with negotiated price reductions, and recently issued a compulsory license to import one patented ARV. In this study, we investigate the drivers of recent ARV cost trends in Brazil through analysis of drug-specific prices and expenditures between 2001 and 2005.Methods and FindingsWe compared Brazil's ARV prices to those in other low- and middle-income countries. We analyzed trends in drug expenditures for HAART in Brazil from 2001 to 2005 on the basis of cost data disaggregated by each ARV purchased by the Brazilian program. We decomposed the overall changes in expenditures to compare the relative impacts of changes in drug prices and drug purchase quantities. We also estimated the excess costs attributable to the difference between prices for generics in Brazil and the lowest global prices for these drugs. Finally, we estimated the savings attributable to Brazil's reduced prices for patented drugs. Negotiated drug prices in Brazil are lowest for patented ARVs for which generic competition is emerging. In recent years, the prices for efavirenz and lopinavir–ritonavir (lopinavir/r) have been lower in Brazil than in other middle-income countries. In contrast, the price of tenofovir is US$200 higher per patient per year than that reported in other middle-income countries. Despite precipitous price declines for four patented ARVs, total Brazilian drug expenditures doubled, to reach US$414 million in 2005. We find that the major driver of cost increases was increased purchase quantities of six specific drugs: patented lopinavir/r, efavirenz, tenofovir, atazanavir, enfuvirtide, and a locally produced generic, fixed-dose combination of zidovudine and lamivudine (AZT/3TC). Because prices declined for many of the patented drugs that constitute the largest share of drug costs, nearly the entire increase in overall drug expenditures between 2001 and 2005 is attributable to increases in drug quantities. Had all drug quantities been held constant from 2001 until 2005 (or for those drugs entering treatment guidelines after 2001, held constant between the year of introduction and 2005), total costs would have increased by only an estimated US$7 million. We estimate that in the absence of price declines for patented drugs, Brazil would have spent a cumulative total of US$2 billion on drugs for HAART between 2001 and 2005, implying a savings of US$1.2 billion from price declines. Finally, in comparing Brazilian prices for locally produced generic ARVs to the lowest international prices meeting global pharmaceutical quality standards, we find that current price...

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“…Medication adherence was assessed using the medication possession ratio (MPR), which has been shown to be the most widely adopted measure (57% of all studies) in published claims-based analyses of medication adherence18 and has been used in studies of ART adherence among individuals with HIV 19. MPR, which is a proxy for refill compliance, generally measures the proportion of the ART-exposure period in which supply was maintained for all ART components comprising the regimen.…”

Section: Methodsmentioning

confidence: 99%

Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV

2013

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ObjectivesLower pill burden leads to improved antiretroviral therapy (ART) adherence among HIV patients. Simpler dosing regimens have not been widely explored in real-world populations. We retrospectively assessed ART adherence, all-cause hospitalisation risk and costs, and other healthcare utilisation and costs in Medicaid enrollees with HIV treated with ART as a once-daily single-tablet regimen (STR) or two or more pills per day (2+PPD).DesignPatients with an HIV diagnosis from 2005 to 2009 receiving complete ART (ie, two nucleoside/nucleotide reverse transcriptase inhibitors plus a third agent) for ≥60 days as STR or 2+PPD were selected and followed until the first of (1) discontinuation of the complete ART, (2) loss of enrolment or (3) end of database. Adherence was measured using the medication possession ratio. Monthly all-cause healthcare utilisation and costs were observed from regimen initiation until follow-up end.ResultsOf the 7381 patients who met inclusion criteria, 1797 were treated with STR and 5584 with 2+PPD. STR patients were significantly more likely to reach 95% adherence and had fewer hospitalisations than 2+PPD patients (both p<0.01). STR patients had mean (SD) total monthly costs of $2959 ($4962); 2+PPD patients had $3544 ($5811; p<0.001). Hospital costs accounted for 53.8% and pharmacy costs accounted for 32.5% of this difference. Multivariate analyses found that STR led to a 23% reduction in hospitalisations and a 17% reduction in overall healthcare costs. ART adherence appears to be a key mechanism mediating hospitalisation risk, as patients with ≥95% adherence (regardless of regimen type) had a lower hospitalisation rate compared with <95% adherence.ConclusionsWhile it was expected that STR patients would have lower pharmacy costs, we also found that STR patients had fewer hospitalisations and lower hospital costs than 2+PPD patients, resulting in significantly lower total healthcare costs for STR patients.

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Adherence to combined Lamivudine+Zidovudine versus individual components: A community-based retrospective medicaid claims analysis

Cited by 29 publications

References 34 publications

Does Synchronizing Initiation of Therapy Affect Adherence to Concomitant Use of Antihypertensive and Lipid-Lowering Therapy?

Does Synchronizing Initiation of Therapy Affect Adherence to Concomitant Use of Antihypertensive and Lipid-Lowering Therapy?

Evolution of Antiretroviral Drug Costs in Brazil in the Context of Free and Universal Access to AIDS Treatment

Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV

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