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Oosterhof P, Wit FWNM, van Luin M, van der Valk M, Brinkman K, Burger DM. First-line antiretroviral therapy initiation for newly diagnosed people with HIV in the Netherlands: A retrospective analysis from 2016 to 2020. PLoS One 2024; 19:e0307963. [PMID: 39058734 PMCID: PMC11280218 DOI: 10.1371/journal.pone.0307963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION HIV treating physicians in the Netherlands follow the guidelines of the Department of Health and Human Services (DHHS). Most of these recommended initial regimens are single-tablet regimens (STRs), which incur higher costs. By the end of 2017, generic NRTI backbones had become widely available, offering a potentially cheaper multi-tablet regimen. This study aimed to evaluate guideline compliance in people with HIV who started antiretroviral therapy (ART), the uptake of generic multi-tablet regimens (gMTRs), and associated medication costs. METHODS This retrospective cohort study used data from the Dutch HIV Monitoring Foundation to determine the proportion of treatment-naïve people entering care who initiated ART according to the DHHS and type of ART regimens prescribed between January 2016 and December 2020. We analyzed ART prescriptions, both at the national level and per individual HIV treatment centers. We calculated the monthly ART costs based on Dutch medicine prices listed on www.medicijnkosten.nl for each calendar year. RESULTS In 2016, an integrase inhibitor-containing regimen was initiated in 77.3% which increased to 87.8% in 2020. The compliance rate to DHHS-recommended initial regimens ranged from 82.8% in 2016 to 90.9% in 2020. Most patients received single-tablet regimens, 81.3% in 2016 to 60.3% in 2020. After the introduction the gMTRs showed a steady increase from 17.8% in 2018 to 37.8% in 2020. The cost of the first-line regimen per patient decreased by 22.9% in 2020 compared with 2017. The decrease was larger in centers where treatment-naïve individuals with HIV were preferentially initiated on a gMTR. CONCLUSIONS There was a high compliance to the "DHHS-recommended initial regimens for most people with HIV" in the Netherlands. Most people who initiated ART received STRs, although the percentage of people who started on STRs gradually decreased over time. The use of gMTRs increased over time and was associated with lower medication costs.
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Affiliation(s)
- Piter Oosterhof
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ferdinand W. N. M. Wit
- Division of Infectious Diseases, Amsterdam University Medical Centers, Location Academic Medical Center, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Matthijs van Luin
- Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, the Netherlands
| | - Marc van der Valk
- Division of Infectious Diseases, Amsterdam University Medical Centers, Location Academic Medical Center, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Kees Brinkman
- Division of Infectious Diseases, Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - David M. Burger
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, The Netherlands
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Leroy P, Diamantis S, Sellier PO, Hamet G, Brun A, Rozenbaum W, Molina JM. Prescriptions of generic antiretroviral drugs in three healthcare centers in the Paris area, France. AIDS 2024; 38:1269-1272. [PMID: 38814716 DOI: 10.1097/qad.0000000000003899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
In a retrospective study conducted in three hospitals in Paris, generic antiretroviral accounted for 30.2% of all prescriptions. Tenofovir disoproxil/emtricitabine (TDF/FTC) was the most prescribed generic ART (82.3% of generic prescriptions). Generic ART (gART) was more likely to be prescribed to women, to patients less than 50 years, and with recent HIV diagnosis less than 3 years. Physicians prescribed more gART if they were men, older than 55 years or worked at a university teaching hospital.
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Affiliation(s)
- Pierre Leroy
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Sud Ile-de-France, Melun
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Sylvain Diamantis
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Sud Ile-de-France, Melun
| | - Pierre-Olivier Sellier
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Sud Ile-de-France, Melun
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Gwenn Hamet
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Alexandre Brun
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Willy Rozenbaum
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Jean-Michel Molina
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
- University of Paris Cité, Paris, France
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Cousien A, Donadille C, Madrid LB, Maradan G, Jauffret-Roustide M, Lalanne L, Auriacombe M, Roux P, Boyer S. Cost-effectiveness of drug consumption rooms in France: a modelling study. BMC Public Health 2024; 24:1426. [PMID: 38807111 PMCID: PMC11135012 DOI: 10.1186/s12889-024-18909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) experience many health problems which result in a heavy economic and public health burden. To tackle this issue, France opened two drug consumption rooms (DCRs) in Paris and Strasbourg in 2016. This study assessed their long-term health benefits, costs and cost-effectiveness. METHODS We developed a model to simulate two fictive cohorts for each city (n=2,997 in Paris and n=2,971 in Strasbourg) i) PWID attending a DCR over the period 2016-2026, ii) PWID attending no DCR. The model accounted for HIV and HCV infections, skin abscesses and related infective endocarditis, drug overdoses and emergency department visits. We estimated the number of health events and associated costs over 2016-2026, the lifetime number of quality-adjusted life-years (QALYs) and costs, and the incremental cost-effectiveness ratio (ICER). RESULTS The numbers of abscesses and associated infective endocarditis, drug overdoses, and emergency department visits decreased significantly in PWID attending DCRs (-77%, -69%, and -65%, respectively) but the impact on HIV and HCV infections was modest (-11% and -6%, respectively). This resulted in savings of €6.6 (Paris) and €5.8 (Strasbourg) millions of medical costs. The ICER of DRCs was €30,600/QALY (Paris) and €9,200/QALY (Strasbourg). In scenario analysis where drug consumption spaces are implemented inside existing harm reduction structures, these ICERs decreased to €21,400/QALY and €2,500/QALY, respectively. CONCLUSIONS Our findings show that DCRs are highly effective and efficient to prevent harms in PWID in France, and advocate extending this intervention to other cities by adding drug consumption spaces inside existing harm reduction centers.
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Affiliation(s)
- Anthony Cousien
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018, Paris, France.
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Cécile Donadille
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Gwenaëlle Maradan
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Jauffret-Roustide
- Centre d'Etudes des Mouvements Sociaux, Inserm U1276, CNRS UMR 8044, EHESS, Paris, France
- British Columbia Center on Substance Use (BCCSU), Vancouver, Canada
- Baldy Center on Law and Social Policy, Buffalo University, New York, USA
- Institut universitaire sur les dépendances, Université de Sherbrooke, Montréal, Québec, Canada
| | - Laurence Lalanne
- UMR 1329, Team Addictions, Centre de recherche en biomédecine de Strasbourg, Department of addiction medicine, University hospital of Strasbourg, Strasbourg, France
| | - Marc Auriacombe
- UMR 6033, Bordeaux University, SANPSY, CNRS, Bordeaux, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Sylvie Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Castry M, Cousien A, Champenois K, Supervie V, Velter A, Ghosn J, Yazdanpanah Y, Paltiel AD, Deuffic‐Burban S. Cost-effectiveness of hepatitis C virus test-and-treat and risk reduction strategies among men who have sex with men living with HIV in France. J Int AIDS Soc 2022; 25:e26035. [PMID: 36451286 PMCID: PMC9712801 DOI: 10.1002/jia2.26035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Studies suggest that hepatitis C virus (HCV) micro-elimination is feasible among men who have sex with men (MSM) living with human immunodeficiency virus (HIV), through treatment-as-prevention and interventions aimed at reducing risk behaviours. However, their economic impact is poorly understood. The aim of this study was to assess the cost-effectiveness of HCV screening and risk reduction strategies in France. METHODS A compartmental deterministic mathematical model was developed to describe HCV disease transmission and progression among MSM living with HIV in France. We evaluated different combinations of HCV screening frequency (every 12, 6 or 3 months) and risk reduction strategies (targeting only high-risk or all MSM) from 2021 onwards. The model simulated the number of HCV infections, life-expectancy (LYs), quality-adjusted life-expectancy (QALYs), lifetime costs and incremental cost-effectiveness ratio (ICER) over a lifetime horizon (leading to an end of the simulation in 2065). RESULTS All strategies increased QALYs, compared with current practices, that is yearly HCV screening, with no risk reduction. A behavioural intervention resulting in a 20% risk reduction in the high-risk group, together with yearly screening, was the least expensive strategy, and, therefore, cost-saving compared to current practices. The ICER per QALY gained for the strategy combining risk reduction for the high-risk group with 6-month HCV screening, compared to risk reduction with yearly screening, was €61,389. It also prevented 398 new HCV infections between 2021 and 2065, with a cost per infection averted of €37,790. All other strategies were dominated (more expensive and less effective than some other available alternative) or not cost-effective (ICER per QALY gained > €100,000). CONCLUSIONS In the French context, current HCV screening practices without risk reduction among MSM living with HIV cannot be justified on economic grounds. Risk reduction interventions targeted to high-risk individuals-alongside screening either once or twice a year-could be cost-effective depending on the policymaker's willingness-to-pay.
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Affiliation(s)
| | | | | | - Virginie Supervie
- Sorbonne UniversitéInsermInstitut Pierre Louis d’Épidémiologie et de Santé PubliqueParisFrance
| | | | - Jade Ghosn
- Université de ParisIAMEINSERMParisFrance,Service de maladies Infectieuses et tropicalesHôpital Bichat Claude BernardParisFrance
| | - Yazdan Yazdanpanah
- Université de ParisIAMEINSERMParisFrance,Service de maladies Infectieuses et tropicalesHôpital Bichat Claude BernardParisFrance
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Ruiz-Algueró M, Alejos B, García Yubero C, Riera Jaume M, Antonio Iribarren J, Asensi V, Pasquau F, Galera CE, Pascual-Carrasco M, Muñoz A, Jarrín I, Suárez-García I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Blanco JL, Garcia F, Rubio R, Iribarren JA, Gutiérrez F, Vidal F, Berenguer J, González J, Alejos B, Hernando V, Moreno C, Iniesta C, Garcia Sousa LM, Perez NS, Muñoz-Fernández MÁ, García-Merino IM, Fernández IC, Rico CG, de la Fuente JG, Concejo PP, Portilla J, Merino E, Reus S, Boix V, Giner L, Gadea C, Portilla I, Pampliega M, Díez M, Rodríguez JC, Sánchez-Payá J, Gómez JL, Hernández J, Alemán MR, del Mar Alonso M, Inmaculada Hernández M, Díaz-Flores F, García D, Pelazas R, Lirola AL, Moreno JS, Caso AA, Hernández Gutiérrez C, Novella Mena M, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Antonio Iribarren J, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Gregori Colomé J, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, José Parras F, Balsalobre P, Diez C, Latorre LP, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, López-Dupla M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Montero Alonso M, López Aldeguer J, Blanes Juliá M, Tasias Pitarch M, Hernández IC, Calabuig Muñoz E, Cuéllar Tovar S, Salavert Lletí M, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Luisa Montes M, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Stella Alcáriz N, Valencia E, Ramón Blanco J, Antonio Oteo J, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Segura F, José Amengual M, Navarro G, Sala M, Cervantes M, Pineda V, Calzado S, Navarro M, de los Santos I, Sanz Sanz J, Aparicio AS, Sarriá Cepeda C, Garcia-Fraile Fraile L, Martín Gayo E, Moreno S, Luis Casado J, Dronda F, Moreno A, Jesús Pérez Elías M, Gómez Ayerbe C, Gutiérrez C, Madrid N, del Campo Terrón S, Martí P, Ansa U, Serrano S, Jesús Vivancos M, Cano A, García AA, Bravo Urbieta J, Muñoz Á, Jose Alcaraz M, Villalba MDC, García F, Hernández J, Peña A, Muñoz L, Casas P, Alvarez M, Chueca N, Vinuesa D, Martinez-Montes C, Romero JD, Rodríguez C, Puerta T, Carlos Carrió J, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, González CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Ferrer E, Imaz A, Tiraboschi J, Silva A, Saumoy M, Ribera E, Curran A, Olalla J, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Stachowski JP, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Sanz Moreno J, Arranz Caso A, Gutiérrez CH, Novella Mena M, Galindo Puerto MJ, Fernando Vilalta R, Ferrer Ribera A, Román AR, Brieva Herrero MT, Juárez AR, López PL, Sánchez IM, Martínez JP, Jiménez MC, Perea RT, Ruiz-Capillas JJJ, Pineda JA. Use of Generic Antiretroviral Drugs and Single-Tablet Regimen De-Simplification for the Treatment of HIV Infection in Spain. AIDS Res Hum Retroviruses 2022; 38:433-440. [PMID: 35357907 DOI: 10.1089/aid.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The present study sought to describe the use of generic drugs and single-tablet regimen (STR) de-simplification for the treatment of human immunodeficiency virus (HIV) infection among 41 hospitals from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). In June 2018, we collected information on when generic antiretroviral drugs (ARVs) were introduced in the different hospitals, how the decisions to use them were made, and how the information was provided to the patients. Most of the nine available generic ARVs in Spain by June 2018 had been introduced in at least 85% of the participating hospitals, except for zidovudine (AZT)/lamivudine (3TC) and AZT. The time difference between the effective marketing date of each generic ARV and its first dispensing date in the hospitals was much shorter for the more recently approved generic ARV since the year 2017. However, only up to 20% of the hospitals de-simplified efavirenz (EFV)/tenofovir disoproxil (TDF)/emtricitabine (FTC), dolutegravir (DTG)/abacavir (ABC)/3TC, and rilpivirine (RPV)/TDF/FTC (to generic EFV+TDF/FTC, DTG+generic ABC/3TC, and RPV+generic TDF/FTC, respectively), whereas the generic STR EFV/TDF/FTC was introduced in 87.8% of the centers. The median times between the date of effective marketing of generic TDF/FTC and the date of de-simplification of EFV/TDF/FTC and RPV/TDF/FTC were 723 [interquartile range (IQR): 369-1,119] and 234 (IQR: 142-264) days, respectively; this time was 155 (IQR: 28-287) days for de-simplification of DTG/ABC/3TC. In conclusion, despite the widespread use of generic ARVs, STRs de-simplification was only undertaken in <20% of the hospitals. There was wide variability in the timing of the introduction of each generic ARV after they were available in the market.
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Affiliation(s)
- Marta Ruiz-Algueró
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Belén Alejos
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
| | | | | | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastián, Spain
| | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Mario Pascual-Carrasco
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Adolfo Muñoz
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Inés Suárez-García
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
- Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain
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Patients' experiences and opinions after de-simplification of their single-tablet regimens for the treatment of HIV infection: a survey in a multicentre cohort. J Acquir Immune Defic Syndr 2022; 90:62-68. [PMID: 35090156 DOI: 10.1097/qai.0000000000002923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to describe patients' experiences after single-tablet regimen (STR) de-simplification, and its impact on self-reported treatment adherence and quality of life. METHODS We performed a survey among all patients from the multicenter cohort of the Spanish HIV/AIDS Network (CoRIS) who had de-simplified the STRs dolutegravir/abacavir/lamivudine (DGT/ABC/3TC) or rilpivirine/tenofovir disoproxil fumarate/emtricitabine (RPV/TDF/FTC) to their separate components (DTG+generic ABC/3TC or RPV+generic TDF/FTC, respectively) between December 2016 and November 2018. RESULTS Among 216 patients who fulfilled inclusion criteria, 138 (63.9%) completed the questionnaire. The majority (78.3%) knew what generic drugs are, only 8.7% thought that treatment with two pills is less effective than treatment with an STR, and 67.4% agreed that it is reasonable to take two pills instead of one for HIV treatment in order to decrease costs for the healthcare system.After de-simplification, 13.0% of the patients stated they had more secondary effects, 8.0% had forgotten one or more doses more frequently than before, and 10.9% had sometimes forgotten to take one pill, but not the other. A proportion of 30.4% reported not being happy to take more pills a day and 10.1% experienced a worse quality of life after the treatment de-simplification. CONCLUSIONS After STR de-simplification, most patients had a fair knowledge about generic antiretrovirals , and they agreed to de-simplify their STR in order to decrease costs. Although almost a third of the respondents were not happy to take two pills a day, only a minority reported worse adherence or quality of life.
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Krentz HB, Campbell S, Lahl M, Gill MJ. Uptake Success and Cost Savings from Switching to a Two-Drug Antiretroviral Regimen. AIDS Patient Care STDS 2022; 36:1-7. [PMID: 34910887 DOI: 10.1089/apc.2021.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The emergence of dual therapy for antiretroviral (ARV)-experienced persons living with HIV (PWH) offers the opportunity to reduce lifetime exposure to unnecessary ARV drugs while maintaining viral suppression and reducing the cost of care. Our objective, using retrospective analysis of a quality care initiative, was to examine in routine clinical practice the clinical impact of switching PWH stable on a three-drug to a two-drug single-tablet formulation (STF) ARV regimen. We also examined the cost implications of this STF adjustment. Between January 1, 2020 and January 1, 2021 eligible patients (i.e., virally suppressed, no active hepatitis B infection, no documented nucleoside reverse transcriptase inhibitors/integrase strand transfer inhibitor resistance) were offered, on a convenience basis and as part of routine care, the opportunity to adjust their current three-drug STF to a two-drug STF (dolutegarvair/lamivudine). The acceptance, clinical efficacy, safety, tolerability, and cost of treatment were measured for patients who switched in 2020. Of 989 eligible PWH, 408 were approached and 391 (39.5%) switched to two-drug regimen; 99% remained on the two-drug STF at year's end (median 240 days follow-up). Only 2/391 patients who switched lost viral control. The total ARV drug cost for all 989 patients decreased by 10.3% generating an actual savings of $1,596,666 among patients approached and switched in 2020. Patient interest and uptake in switching to two-drug STF was substantial and resulted in few discontinuations for any reason. It provided significant and immediate cost savings within the first year. Our results bring clarity to discussions on whether using two-drug regimens would be practical and acceptable in nonclinical trial settings.
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Affiliation(s)
- Hartmut B. Krentz
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | | | | | - M. John Gill
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
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Papot E, Kalampalikis N, Doumergue M, Pilorgé F, Quatremère G, Yazdanpanah Y, Préau M. Can we talk about price with patients when choosing antiretroviral therapy? A survey with people living with HIV and prescribers in France. BMJ Open 2021; 11:e046212. [PMID: 34836895 PMCID: PMC8628338 DOI: 10.1136/bmjopen-2020-046212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate people living with HIV (PLWH) and HIV specialist prescribers' perception of discussing antiretroviral therapy (ART) price in PLWH's care and the acceptability of choosing or switching to various types of less expensive ARTs. DESIGN Cross-sectional surveys (one in a convenience sample of PLWH and one in a voluntary response sample of HIV specialist prescribers). SETTING AND PARTICIPANTS The surveys were conducted among PLHW attending an HIV clinic in the North of Paris (cohort of 4922 PLWH in 2016), and HIV specialists working in French HIV clinics (210 across 12 districts/28), between January and June 2016. METHOD Self-administered questionnaires were constructed using data collected during focus groups with PLWH and prescribers. Pretests were carried out to select the questions and items. Descriptive analyses of the 129 complete questionnaires of PLWH and 79 of prescribers are presented. RESULTS Among PLWH, 128/129 were on ART and 54% (69/128) gave a fair estimation of the price of their current regimen. Among prescribers, 24% (19/79) thought that their patients knew this price. Taking into account the price of ART was not perceived as a negative step in the history of French response to HIV epidemic for 53% (68/129) of PLWH and 82% (65/79) of prescribers. Seventy-seven PLWH (60%) would agree to switch to less expensive antiretroviral regimens (as effective and with similar adverse events) if pills were bigger; 42 (33%) if there were more daily doses, and 37 (29%) if there were more pills per dose; prescribers were more circumspect. CONCLUSION A high proportion of PLWH gave a fair estimate of their ART price and this seemed unexpected by HIV specialists. Consideration of drug prices when choosing ART was perceived as conceivable by PLWH and prescribers if effectiveness and tolerance were also considered.
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Affiliation(s)
- Emmanuelle Papot
- Université de Paris, INSERM, IAME, F-75006, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, F-75018 Paris, France
| | | | | | | | | | - Yazdan Yazdanpanah
- Université de Paris, INSERM, IAME, F-75006, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, F-75018 Paris, France
| | - Marie Préau
- UMR 1296 « Radiations : Défense, Santé, Environnement », Université Lumière Lyon 2, Institut de Psychologie, Bron, France
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Suárez‐García I, Alejos B, Ruiz‐Algueró M, García Yubero C, Moreno C, Bernal E, Pérez‐Is L, Zubero Z, de Zárraga Fernández MA, Samperiz Abad G, Jarrín I. Effectiveness and tolerability of dolutegravir and abacavir/lamivudine administered as two separate pills compared to their equivalent single-tablet regimen in a multicentre cohort in Spain. J Int AIDS Soc 2021; 24:e25758. [PMID: 34291580 PMCID: PMC8295592 DOI: 10.1002/jia2.25758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION We aimed to assess the effectiveness and tolerability of dolutegravir (DTG), abacavir (ABC) and lamivudine (3TC) administered as branded STR (DTG/ABC/3TC) or as two separate pills (DTG and either branded ABC/3TC [DTG+(ABC/3TC)b] or generic ABC/3TC [DTG+(ABC/3TC)g]). METHODS We included individuals from the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) who received DTG/ABC/3TC, DTG+(ABC/3TC)b or DTG+(ABC/3TC)g during 2015 to 2018. We used multivariable logistic regression to compare the proportion of antiretroviral-naïve individuals who achieved viral suppression (VS) (viral load ≤50 copies/mL) at 24 weeks of initiating with DTG+(ABC/3TC)b or DTG+(ABC/3TC)g versus DTG/ABC/3TC. We also calculated the proportion of virologically suppressed individuals who maintained VS at 24 weeks after switching from DTG/ABC/3TC to DTG+(ABC/3TC)g. RESULTS During the study period, 829, 68 and 47 treatment-naïve individuals started treatment with DTG/ABC/3TC, DTG+(ABC/3TC)b or DTG+(ABC/3TC)g respectively. The proportions of individuals who changed their regimens due to side effects during the first 24 weeks were 3.7%, 4.4% and 6.4% respectively (p = 0.646). We did not find significant differences in VS at 24 weeks among individuals starting with DTG+(ABC/3TC)b or DTG+(ABC/3TC)g compared to those initiating with DTG/ABC/3TC. Among 177 virologically suppressed individuals who switched from DTG/ABC/3TC to DTG+(ABC/3TC)g, 170 (96.0%) maintained VS at 24 weeks. CONCLUSIONS In naïve individuals, the effectiveness and tolerability at 24 weeks of DTG plus ABC/3TC administered as two separate pills, either as branded or generic ABC/3TC, was similar to the STR DTG/ABC/3TC. Switching the STR DTG/ABC/3TC to its separate components DTG+(ABC/3TC)g in virologically suppressed individuals did not seem to impair its effectiveness.
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Affiliation(s)
- Inés Suárez‐García
- Infectious Diseases GroupDepartment of Internal MedicineHospital Universitario Infanta Sofía (FIIB HUIS HHEN)MadridSpain
- Universidad EuropeaMadridSpain
| | - Belén Alejos
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
| | | | - Cristina García Yubero
- Department of Hospital PharmacyHospital Universitario Infanta Sofía (FIIB HUIS HHEN)MadridSpain
| | - Cristina Moreno
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
| | - Enrique Bernal
- Infectious Diseases SectionHospital General Universitario Reina SofíaMurciaSpain
| | - Laura Pérez‐Is
- FINBA/ISPAHospital Universitario Central de AsturiasAvilésSpain
| | - Zuriñe Zubero
- Department of Infectious Diseases. HospitalUniversitario BasurtoBizkaiaSpain
| | | | | | - Inma Jarrín
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
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Suárez-García I, Ruiz-Algueró M, García Yubero C, Moreno C, Belza MJ, Estébanez M, de Los Santos I, Masiá M, Samperiz Abad G, Muñoz Sánchez J, Omar M, Jarrín I. Physicians' opinions on generic antiretroviral drugs and single-tablet regimen de-simplification for the treatment of HIV infection: a multicentre survey in Spain. J Antimicrob Chemother 2021; 75:466-472. [PMID: 31665404 DOI: 10.1093/jac/dkz439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the attitudes and opinions about generic antiretroviral drugs (ARVs) and single-tablet regimen (STR) de-simplification among physicians prescribing HIV treatment in the cohort of the Spanish HIV/AIDS Research Network (CoRIS). METHODS An online questionnaire with 27 structured questions was sent to all physicians (n=199) who prescribed ARVs among the 45 centres participating in the cohort. RESULTS A total of 169 (84.9%) physicians answered the questionnaire. Only 4.1% of the physicians would never prescribe generic ARVs, but 53.3% would not prescribe them if the number of pills per day increased and 89.3% would not prescribe them if the number of doses per day increased. However, 84.0% of the physicians agreed to prescribe generic ARVs if doing so would decrease costs for the public healthcare system. The percentages of physicians stating that generic ARVs (compared with branded ones) would be associated with worse adherence, more adverse effects or more probability of virological failure, provided that the number of pills and doses per day would not change, were low: 0.6%, 7.7% and 3.6%, respectively. However, these percentages were much higher if the generic ARV entailed breaking an STR: 63.9%, 18.9% and 42.0%, respectively. Most physicians stated that they needed more information about the effectiveness and safety of generic ARVs and the price difference compared with their branded equivalents. CONCLUSIONS Although most physicians were confident about prescribing generic ARVs, the majority had strong concerns about de-simplifying STR, and they also needed more information about generic drugs.
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Affiliation(s)
- Inés Suárez-García
- Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain.,Facultad de Ciencias Biomédicas, Universidad Europea, Madrid, Spain
| | - Marta Ruiz-Algueró
- National Epidemiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cristina Moreno
- National Epidemiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | - María José Belza
- National School of Health, Instituto de Salud Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - Miriam Estébanez
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario 'Gómez Ulla', Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá de Henares, Madrid, Spain
| | | | - Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Josefa Muñoz Sánchez
- Department of Infectious Diseases, Hospital Universitario Basurto, Bizkaia, Spain
| | - Mohamed Omar
- Infectious Diseases Unit, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Inma Jarrín
- National Epidemiology Centre, Instituto de Salud Carlos III, Madrid, Spain
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Comorbidities in people living with HIV: An epidemiologic and economic analysis using a claims database in France. PLoS One 2020; 15:e0243529. [PMID: 33332394 PMCID: PMC7746269 DOI: 10.1371/journal.pone.0243529] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/24/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES As people living with HIV (PLHIV) age, the burden of non-HIV related comorbidities increases resulting in additional healthcare costs. The present study aimed to describe the profile, the prevalence and the incremental costs of non-HIV related comorbidities in PLHIV compared to non-HIV matched controls (1:2 ratio) in France. METHODS The French permanent sample of health beneficiaries (Echantillon généraliste de bénéficiaires [EGB]), a claims database representative of the national population, was used to assess comorbidities in PLHIV which were identified by the ICD-10 diagnosis codes of hospitalization, full healthcare coverage, and drug reimbursements between 2011 and 2014. The control group was matched by year of birth, gender, region of residence, and economic status. Total costs of outpatient care and hospitalizations were analysed from a societal perspective. A general linear model was used to assess the incremental cost per patient in PLHIV. RESULTS A total of 1,091 PLHIV and 2,181 matched controls were identified with a mean ± standard deviation age of 46.7 ± 11.5 years. The prevalence of alcohol abuse (5.8% vs 3.1%; p<0.001), chronic renal disease (1.2% vs 0.3%; p = 0.003), cardiovascular disease (7.4% vs 5.1%; p = 0.009), dyslipidaemia (22% vs 15.9%; p<0.001), hepatitis B (3.8% vs 0.1%; p<0.001) and hepatitis C (12.5% vs 0.6%; p<0.001) was significantly higher in PLHIV compared with non-HIV controls. Other comorbidities such as anaemia, malnutrition, psychiatric diseases, and neoplasms were also more prevalent in PLHIV. Hospitalizations were significantly increased in PLHIV compared to controls (33.2% vs 16%; p<0.001). Mean total cost was 6 times higher for PLHIV compared to controls and 4 times higher after excluding antiretroviral drugs (9,952€ vs. 2,593€; p<0.001). Higher costs per person in PLHIV were significantly associated to aging (42€ per patient/year), chronic cardiovascular disease (3,003€), hepatitis C (6,705€), metastatic carcinoma (6,880€) and moderate or severe liver disease (6,299€). CONCLUSION Our results demonstrated an increase in non-HIV related comorbidities among PLHIV compared to matched controls. This study contributes to raise awareness on the burden of chronic comorbidities.
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Krentz H, Campbell S, Gill J. Desimplification of Single Tablet Antiretroviral (ART) Regimens-A Practical Cost-Savings Strategy? J Int Assoc Provid AIDS Care 2020; 18:2325958218822304. [PMID: 30672364 PMCID: PMC6748513 DOI: 10.1177/2325958218822304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The use of lifelong antiretroviral therapy (ART) results in increased costs of care; the ability to finance and control sustained costs of ART needs to be discussed. APPROACH The Southern Alberta Clinic initiated a practical cost savings approach that switched select patients from a branded ART to a less expensive generic variation. Our approach surveyed physicians and patients on their acceptance of switching and then launched a program asking patients if they would switch to generic variations for cost control purposes. RESULTS Our early findings found >50% of patients approached agreed to switch. We found no evidence of increased risk of viral breakthrough, resistance, side effects, or displeasure with generic drugs. Measured cost savings in the first year were >$1.1 million with annual projected savings of between $4.3 million and $2.6 million (in 2017 Cdn$). CONCLUSION Our approach can provide an option for controlling costs of HIV care without compromising quality.
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Affiliation(s)
- Hartmut Krentz
- 1 Southern Alberta Clinic, Calgary, Canada.,2 Department of Medicine, University of Calgary, Calgary, Canada
| | | | - John Gill
- 1 Southern Alberta Clinic, Calgary, Canada.,2 Department of Medicine, University of Calgary, Calgary, Canada
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Garay OU, Nishimwe ML, Bousmah MAQ, Janah A, Girard PM, Chêne G, Moinot L, Sagaon-Teyssier L, Meynard JL, Spire B, Boyer S. Cost-Effectiveness Analysis of Lopinavir/Ritonavir Monotherapy Versus Standard Combination Antiretroviral Therapy in HIV-1 Infected Patients with Viral Suppression in France (ANRS 140 DREAM). PHARMACOECONOMICS - OPEN 2019; 3:505-515. [PMID: 30968368 PMCID: PMC6861410 DOI: 10.1007/s41669-019-0130-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Protease inhibitor monotherapy is a simplified treatment strategy for virally suppressed HIV-positive patients that has the potential for cost savings, as fewer drugs are used than with combination therapy. However, evidence for its economic value is limited. OBJECTIVES We assessed the cost-effectiveness of lopinavir/ritonavir monotherapy followed by treatment intensification in case of viral load rebound versus combination antiretroviral therapy (cART) with efavirenz/emtricitabine/tenofovir in HIV-1 infected patients with viral suppression in the ANRS 140 DREAM trial. METHODS DREAM was conducted in 36 French Hospitals between 2009 and 2013. For each treatment strategy, we estimated the unadjusted and multivariate-adjusted mean costs (in €, year 2010 values) and quality-adjusted life-years (QALYs) per patient, as well as incremental costs and QALYs per patient. We then assessed uncertainty using the cost-effectiveness acceptability curve, scenario analyses and cost-effectiveness price-threshold (CEPT) analysis. RESULTS In the base-case analysis considering 2009-2013 antiretroviral drug (ARV) prices, adjusted incremental costs and QALYs were - €3296 (95% confidence interval [CI] - 5202 to - 1391) and 0.006 (95% CI - 0.021 to 0.033), respectively, over 2 years, suggesting that monotherapy was cost-effective with a probability of 100% at various cost-effectiveness thresholds. In scenario analyses considering 2018 ARV prices, monotherapy remained cost-effective but with a lower probability (94% vs. 100% in the base-case analysis). The current price of cART would have to decrease by 34% to be cost-effective with a probability of 95%. CONCLUSION Monotherapy appears to be cost-effective compared with cART for virologically suppressed HIV-positive patients in France. CEPT analysis is a useful tool to identify the preferred strategy to adopt given that ARV prices change rapidly. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT00946595.
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Affiliation(s)
- Osvaldo Ulises Garay
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | - Marie Libérée Nishimwe
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | - Marwân-Al-Qays Bousmah
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Asmaa Janah
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | | | - Geneviève Chêne
- INSERM Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, ISPED, 33000, Bordeaux, France
- CHU Bordeaux, Division of Public Health, 33000, Bordeaux, France
| | - Laetitia Moinot
- INSERM Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, ISPED, 33000, Bordeaux, France
| | - Luis Sagaon-Teyssier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | - Sylvie Boyer
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France.
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Krentz HB, Campbell S, Lahl M, Gill MJ. De-simplifying single-tablet antiretroviral treatments: uptake, risks and cost savings. HIV Med 2019; 20:214-221. [PMID: 30632660 DOI: 10.1111/hiv.12701] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
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 < 0.05). Preference for STF was cited for declining de-simplification. No concern about generic ARVs was expressed. The rate of viral load > 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.
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Affiliation(s)
- H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Campbell
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M Lahl
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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Rwagitinywa J, Lapeyre-Mestre M, Bourrel R, Montastruc JL, Sommet A. Comparison of adherence to generic multi-tablet regimens vs. brand multi-tablet and brand single-tablet regimens likely to incorporate generic antiretroviral drugs by breaking or not fixed-dose combinations in HIV-infected patients. Fundam Clin Pharmacol 2018; 32:450-458. [PMID: 29505661 DOI: 10.1111/fcp.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/27/2018] [Accepted: 02/27/2018] [Indexed: 12/01/2022]
Abstract
Adherence to antiretroviral (ARV) is crucial to achieve viral load suppression in HIV-infected patients. This study aimed to compare adherence to generic multi-tablet regimens (MTR) vs. brand MTR likely to incorporate ARV drugs without breaking fixed-dose combinations (FDC) and brand single-tablet regimens (STR) likely to incorporate generics by breaking the FDC. Patients aged of 18 years or over exposed to one of the generic or the brand of lamivudine (3TC), zidovudine/lamivudine (AZT/TC), nevirapine (NVP), or efavirenz (EFV), or the brand STR of efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF). Adherence was measured by medication possession ratio (MPR) using both defined daily dose (DDD) and daily number of tablet recommended for adults (DNT). Adherence to generic MTR vs. brand MTR and brand STR was compared using Kruskal-Wallis. The overall median adherence was 0.97 (IQR 0.13) by DNT method and 0.97 (0.14) by DDD method. Adherence in patients exposed to generic MTR (n = 165) vs. brand MTR (n = 481) and brand STR (n = 470) was comparable by DNT and DDD methods. In conclusion, adherence to generic MTR was high and comparable with adherence to brand MTR and to STR. Utilization of DDD instead DNT to measure the MPR led to small but nonsignificant difference that has no clinical impact.
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Affiliation(s)
- Joseph Rwagitinywa
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.,UMR NSERM 1027, University Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.,UMR NSERM 1027, University Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059, Toulouse Cedex 9, France
| | - Robert Bourrel
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAMTS), Direction de l'échelon médical, 3 Boulevard Léopold Escande, 31000, Toulouse, France
| | - Jean-Louis Montastruc
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.,UMR NSERM 1027, University Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059, Toulouse Cedex 9, France
| | - Agnès Sommet
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.,UMR NSERM 1027, University Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059, Toulouse Cedex 9, France
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Krentz HB, Campbell S, Gill VC, Gill MJ. Patient perspectives on de-simplifying their single-tablet co-formulated antiretroviral therapy for societal cost savings. HIV Med 2018; 19:290-298. [PMID: 29368401 DOI: 10.1111/hiv.12578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The incremental costs of expanding antiretroviral (ARV) drug treatment to all HIV-infected patients are substantial, so cost-saving initiatives are important. Our objectives were to determine the acceptability and financial impact of de-simplifying (i.e. switching) more expensive single-tablet formulations (STFs) to less expensive generic-based multi-tablet components. We determined physician and patient perceptions and acceptance of STF de-simplification within the context of a publicly funded ARV budget. METHODS Programme costs were calculated for patients on ARVs followed at the Southern Alberta Clinic, Canada during 2016 (Cdn$). We focused on patients receiving Triumeq® and determined the savings if patients de-simplified to eligible generic co-formulations. We surveyed all prescribing physicians and a convenience sample of patients taking Triumeq® to see if, for budgetary purposes, they felt that de-simplification would be acceptable. RESULTS Of 1780 patients receiving ARVs, 62% (n = 1038) were on STF; 58% (n = 607) of patients on STF were on Triumeq®. The total annual cost of ARVs was $26 222 760. The cost for Triumeq® was $8 292 600. If every patient on Triumeq® switched to generic abacavir/lamivudine and Tivicay® (dolutegravir), total costs would decrease by $4 325 040. All physicians (n = 13) felt that de-simplifying could be safely achieved. Forty-eight per cent of 221 patients surveyed were agreeable to de-simplifying for altruistic reasons, 27% said no, and 25% said maybe. CONCLUSIONS De-simplifying Triumeq® generates large cost savings. Additional savings could be achieved by de-simplifying other STFs. Both physicians and patients agreed that selective de-simplification was acceptable; however, it may not be acceptable to every patient. Monitoring the medical and cost impacts of de-simplification strategies seems warranted.
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Affiliation(s)
- H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Campbell
- Southern Alberta Clinic, Calgary, AB, Canada
| | - V C Gill
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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Rwagitinywa J, Sommet A, Palmaro A, Montastruc JL, Lapeyre-Mestre M. Utilization and costs of HIV antiretroviral drugs in Europe during the last ten years: Impact of generic antiretroviral drugs on cost reduction. Health Policy 2018; 122:237-242. [PMID: 29398158 DOI: 10.1016/j.healthpol.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/24/2017] [Accepted: 01/04/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Simulation studies showed that generic antiretroviral (ARV) drug utilization could lead to significant cost reduction of HIV treatment in developed world. This study aimed to quantify ARV utilization and costs in European countries between 2006 and 2015. We also assessed the impact of generic ARV drug utilization on cost reduction in real-life. METHODS ARV drug utilization in 14 European countries (France, Italy, Germany, Denmark, Netherlands, Norway, Sweden, Finland, Iceland, Croatia, Czech Republic, Estonia, Latvia, and Lithuania) were analysed using defined daily dose (DDD)/1000 inhabitants/year. ARV drug cost was estimated in million euro/year and euro/1000 inhabitants/year. The impact of generics on cost reduction was assessed in three countries: France, Denmark, and Czech Republic, using four parameters: expected savings, observed savings, brand price-reduction savings and overall savings. RESULTS Between 2006 and 2015, median ARV drug utilization increased from 234 DDDs per 1000 inhabitants per year (IQR 124-388) to 385 (229-670). The median cost increased from €3751/1000 inhabitants/year (1109-4681) to €9158 (3269-10,646). Between 2013 and 2015, overall savings of €0.9, €1.6, and €33.7 million were respectively observed in Denmark, Czech Republic, and France. CONCLUSION Overall savings observed in real-life from generic ARV drugs in Denmark were related to high rate of low-price generic utilization, contrarily to France and Czech Republic where these were more related to brand price-reduction than generic utilization itself.
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Affiliation(s)
- Joseph Rwagitinywa
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; UMR NSERM 1027, University Toulouse III, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France.
| | - Agnès Sommet
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; UMR NSERM 1027, University Toulouse III, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059 Toulouse Cedex 9, France.
| | - Aurore Palmaro
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; UMR NSERM 1027, University Toulouse III, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059 Toulouse Cedex 9, France.
| | - Jean-Louis Montastruc
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; UMR NSERM 1027, University Toulouse III, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059 Toulouse Cedex 9, France.
| | - Maryse Lapeyre-Mestre
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; UMR NSERM 1027, University Toulouse III, Faculté de Médecine, 37, Allée Jules Guesde, 31000 Toulouse, France; CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059 Toulouse Cedex 9, France.
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Rwagitinywa J, Lapeyre-Mestre M, Bourrel R, Sommet A. Generic antiretroviral drug use in HIV-infected patients: A cohort study from the French health insurance database. Therapie 2017; 73:257-266. [PMID: 29195713 DOI: 10.1016/j.therap.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/26/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to estimate the rate of generic users among HIV-infected patients treated by antiretroviral (ARV) drugs potentially substitutable and to determine factors associated with switch from brand to generic ARV in real-life settings in a French region. METHODS Cohort of HIV-infected patients aged of ≥18 years, exposed to at least one of the generic of lamivudine (3TC-150mg/300mg), zidovudine/lamivudine (AZT-200mg/3TC-150mg), nevirapine (NVP-200mg), efavirenz (EFV-600mg) and those exposed to brand 3TC, AZT/3TC, NVP, EFV, the fixed-dose combination abacavir/lamivudine (ABC/3TC) or the single-tablet regimen efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF) as recorded in the French health insurance database between January 2012 and May 2015 were included. Factors associated with switch (for each generic versus its brand drug; and for situation requiring breaking the combination) were investigated through a logistic regression. RESULTS Among the 1539 patients likely to switch from brand ARV drugs, only 165 (11%) were exposed to generics. For EFV users, switch from brand to generic was associated with age (aOR=1.04 [CI: 1.00-1.08]). For ABC/3TC users, switch was significantly more frequent in patients receiving a monthly average of more than two non-ARV drugs (3.08 [1.42-6.68]) and whose regimen contained a non-nucleoside reverse transcriptase inhibitor (NNRTI) as index medication (3rd agent) (5.68 [2.68-11.39]). By contrast, switch was less frequent in AZT/3TC users exposed to drugs used in digestive disorders (0.39 [0.18-0.88]) or analgesics (0.42 [0.20-0.90]). CONCLUSION Treatment-experienced HIV patients whose disease has been stabilized (less comorbidities) are more likely to switch to generic antiretroviral drugs.
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Affiliation(s)
- Joseph Rwagitinywa
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France.
| | - Maryse Lapeyre-Mestre
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France; CIC 1436, Toulouse university hospital, 31000 Toulouse, France
| | - Robert Bourrel
- Direction de l'échelon médical, Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 31000 Toulouse, France
| | - Agnès Sommet
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France; CIC 1436, Toulouse university hospital, 31000 Toulouse, France
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