Five-Year Trends in Antiretroviral Usage and Drug Costs in HIV-Infected Children in Thailand

Abstract

Background As antiretroviral treatment (ART) programmes mature, data on drug utilization and costs are needed to assess durability of treatments and inform programme planning. Methods Children initiating ART were followed in an observational cohort in Thailand. Treatment histories from 1999–2009 were reviewed. Treatment changes were categorized as: drug substitution (within class), switch across drug class (non-nucleoside reverse-transcriptase inhibitors (NNRTIs) and protease-inhibitor (PI), and to salvage therapy (dual PI or PI and NNRTI). Antiretroviral drug costs were calculated in six-month cycles (US$ 2009 prices). Predictors of high drug cost including characteristics at start of ART (baseline), initial regimen, treatment change and duration on ART were assessed using mixed-effects regression models. Results 507 children initiated ART with a median 54 (IQR, 36–72) months of follow-up. Fifty-two percent had a drug substitution, 21% switched across class and 2% to salvage therapy. When allowing for drug substitution, 78% remained on their initial regimen. Mean drug cost increased from $251 to $428 per child per year in the first and fifth year of therapy, respectively. PI-based and salvage regimens accounted for 16% and 2% of treatments prescribed and 33% and 5% of total costs, respectively. Predictors of high cost include: baseline age ≥8 years, non nevirapine-based initial regimen; switch across drug class and to salvage regimen (p<0.005). Conclusion At 5 years, 21% of children switched across drug class and 2% received salvage therapy. The mean drug cost increased by 70%. Access to affordable second and third-line drugs is essential for the sustainability of treatment programmes.

Costs of Care of HIV-Infected Children Initiating Lopinavir/Ritonavir-Based Antiretroviral Therapy before the Age of Two in Cote d’Ivoire

“…They do not reflect the overall costs for the implementation of early LPV/r-based ART, nor the long-term costs related to possible toxicity or poor adherence. However, our results are consistent with findings from other pediatric HIV treatment programs, again supporting the urgent need to increase access to ART the earliest possible [15,39–42]. …”

“…These data, estimating patient costs of care will provide inputs for analyses modeling costs and cost-effectiveness of competing programmatic approaches [14,15]. This study assessed data on all costs of care in HIV-infected children during the first 12-months on LPV/r-based ART initiated before the age of 2 years, between 2011–2014, in Abidjan, Côte d’Ivoire.…”

Outcomes after viral load rebound on first-line antiretroviral treatment in children with HIV in the UK and Ireland: an observational cohort study

“…Among patients who switched to second-line therapy in our study, we found a median [IQR] time from VL rebound to switch of 4·9 months [1·7-13·4] which is comparable or slightly shorter than studies in resource limited settings 21,25 . When changing the VL rebound threshold to two consecutive viral load measurements above 1,000c/ml and 5,000c/ml, not surprisingly we found a higher estimated proportion of patients switching to second line therapy while the probability of resuppression without switch decreased with higher VL thresholds.…”

“…The median age, viral load, CD4 count, and CD4% at VL rebound were 10·6 years [5·6-13·4], 3·6 log 10 c/ml [3·1-4·2], 550 cells/μl , and 24% [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], respectively, and three-quarters of children initiated on a NNRTI-based regimen. Fifty one (30%) had already experienced some ART modifications not meeting the definition of switch prior to VL rebound.…”

“…We identified 17 publications with data on children from a variety of settings which analysed either long-term virological patient outcomes 1,3,4,13,25 , durability of first-line ART 2,9,18,19,22 or response to second-line ART 8,23,24,[26][27][28][29] . Only two studies have reported outcomes following viral load rebound and the probability of switch or resuppression without switch in routine care 19,22 .…”