Antiretroviral treatment switch strategies for lowering the costs of antiretroviral therapy in subjects with suppressed HIV-1 viremia in Spain

Abstract

BackgroundThe current economic recession in European countries has forced governments to design emergency measures to reduce spending on drugs, including antiretroviral therapy (ART). Switching antiretroviral drugs for others that have the same efficacy and safety profile at a lower cost (cost-reduction measures, CRM) could prove to be a valid means of generating savings.MethodsDescriptive study of prospective consensus-based CRM undertaken in 2011 in a Catalonian hospital HIV unit among patients with prolonged plasma HIV-1 RNA <50 copies/mL.ResultsDuring the study period, we made 673 switches (87.5% more than the previous year), of which 378 (56.2%) were CRM (16% of all patients treated), leading to a savings of €87,410/month. Switching tenofovir/emtricitabine for abacavir/lamivudine was the most common CRM (129, 31.3%), followed by simplification to boosted protease inhibitor monotherapy (bPImono, 102, 26%). The CRM that generated the greatest saving were switching to bPImono (38%), withdrawal or replacement of raltegravir (24%), switching tenofovir/emtricitabine for abacavir/lamivudine (13%), and switching to nevirapine (5%). Cost savings with CRM were slightly higher than those achieved with medication paid for by clinical trial sponsors (€80,333/month) or through discount arrangements (€76,389/month).ConclusionProactively switching antiretroviral therapy in selected treated patients with sustained virological suppression can generate significant cost savings in pharmacy spending in developed countries. These findings have implications for decision makers in designing safe strategies that maintain HIV-1 suppression at lower costs.

Budget impact analysis of the simplification to atazanavir + ritonavir + lamivudine dual therapy of HIV-positive patients receiving atazanavir-based triple therapies in Italy starting from data of the Atlas-M trial

“…At an international level, two articles proposed economic analysis of cost containment strategies in the field of HIV in Spain24 and in the UK 25. Llibre et al investigated the potential decrease in ART costs because of different therapy switch strategies within a hospital in Catalonia 24.…”

“…Llibre et al investigated the potential decrease in ART costs because of different therapy switch strategies within a hospital in Catalonia 24. The three main cost reduction strategies were switches to PI monotherapies, withdrawal of high cost molecules, and switch to less expensive backbones.…”

Antiretroviral reduction

“…Cost analyses of the MONotherapy in Europe with TMC114 trial (MONET) trial showed a cost reduction of 52% with darunavir-ritonavir monotherapy compared to standard triple therapy [17]. Similarly, a 38% reduction in cost was shown in a Spanish observational cohort when switching from triple therapy to PI/r monotherapy [18]. These published data are in line with our deduction of potential costs savings in the United States based on the recommended monthly wholesale cost for commonly used regimens [14].…”

HIV Clinical Pathway: A New Approach to Combine Guidelines and Sustainability of Anti-Retroviral Treatment in Italy

“…In particular, the most relevant strategies were: (i) the rational use of diagnostic testing [5]; (ii) the implementation of health economics approach, in particular the definition of cost-effectiveness criteria [6], to compare the performance of different therapeutic alternatives, in addition to an economic forecast concerning the overall budget devoted to PLHIV treatment and care [7,8]; (iii) the use of protease inhibitor (PI) mono and dual therapies, the administration of Non-Nucleoside Reverse-Transcriptase Inhibitors (NNRTI)-based, instead of PI-based regimens, and the introduction of generic anti-retroviral drugs [5,6,7]. All these strategies could impact on the performances of the Hospitals Units and clinicians, taking in charge PLHIV and dealing with the problem of HIV, modifying the approach to the patients.…”