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De‐simplifying single‐tablet antiretroviral treatments: uptake, risks and cost savings
Author(s) -
Krentz HB,
Campbell S,
Lahl M,
Gill MJ
Publication year - 2019
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12701
Subject(s) - medicine , abacavir , lamivudine , viral load , incentive , human immunodeficiency virus (hiv) , antiretroviral therapy , generic drug , family medicine , drug , pharmacology , virology , hepatitis b virus , virus , economics , microeconomics
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 ARV s 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.