September 2012, 2:16,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 03 Sep 2012
Cost analysis of HIV treatment and drug-related adverse events when fixed-dose combinations of antiretrovirals (FDCs) were stopped, versus continuation with FDCs
The lower sales price of generic lamivudine has caused healthcare administrators to consider abolishing fixed-dose antiretroviral combinations (FDCs) that contain lamivudine and emtricitabine. The alternative is to administer the individual components of the FDCs separately, thus incorporating the new generic lamivudine medication.
The Balearic Islands Health Service ordered the discontinuation of the treatment with FDCs in July 2010, but FDCs were reintroduced in August 2010. At that point, an independent, retrospective cost analysis was performed by Son Llàtzer Hospital. A total of 75 patients who were treated from July to August 2010 underwent replacement of their FDC treatment with the individual components. Additionally, 150 patients who continued using FDCs were randomly selected. For both patient groups, the antiretroviral therapy that was administered and the costs associated with management of adverse events were recorded. The study period used for the cost calculations was the average number of days that patients used separate components of FDCs (120 days). An alternative analysis was performed to consider the costs of the extra follow-up visit (consultation and clinical tests) that was required for patients who changed their antiretroviral therapy.
Considering antiretroviral therapies and adverse events, the administration of the separate components increased the total daily cost by 0.72 € per patient compared to treatment with FDCs. When the cost of an extra follow-up visit was considered, the daily cost increased by 3.61 € per patient.
Our study suggests that the discontinuation of FDC treatment and the replacement with the administration of separate antiretroviral agents could lead to an increase in healthcare costs due to the higher rate of adverse events that was observed with the discontinuation of FDCs.
Spanish general council of official colleges of pharmacists - botplus. https://botplusweb.portalfarma.com/.
Royal decree-law 4/2010, May 26. http://www.msps.es/profesionales/farmacia/pdf/margenesFactoresConversion.pdf.
Spanish database of healthcare costs - Oblikue (eSalud). http://www.oblikue.com/bddcostes/.
Svicher V, Alteri C, Artese A, Forbici F, Santoro MM, Schols D, Van Laethem K, Alcaro S, Costa G, Tommasi C, Zaccarelli M, Narciso P, Antinori A, Ceccherini-Silberstein F, Balzarini J, Perno CF: Different evolution of genotypic resistance profiles to emtricitabine versus lamivudine in tenofovir-containing regimens. J Acquir Immune Defic Syndr 2010,55(3):336–344.PubMedCrossRef
Cohen C, Davis KL, Meyers JL: Association between daily antiretroviral pill burden and hospitalization risk in a medicaid population With HIV. Chicago, IL; 2011. [CAAC'2011: 51st interscience conference on antimicrobial agents and chemotherapy]
Lubomirov R, Colombo S, di Iulio J, Ledergerber B, Martinez R, Cavassini M, Hirschel B, Bernasconi E, Elzi L, Vernazza P, Furrer H, Günthard HF, Telenti A, Swiss HIV Cohort Study: Association of pharmacogenetic markers with premature discontinuation of first-line anti-HIV therapy: an observational cohort study. J Infect Dis 2011, 203:246–257.PubMedCrossRef
Dejesus E, Young B, Morales-Ramirez JO, Sloan L, Ward DJ, Flaherty JF, Ebrahimi R, Maa JF, Reilly K, Ecker J, McColl D, Seekins D, Farajallah A: Simplification of antiretroviral therapy to a single-tablet regimen consisting of efavirenz, emtricitabine, and tenofovir disoproxil fumarate versus unmodified antiretroviral therapy in virologically suppressed HIV-1-infected patients. J Acquir Immune Defic Syndr 2009,51(2):163–174.PubMedCrossRef
- Cost analysis of HIV treatment and drug-related adverse events when fixed-dose combinations of antiretrovirals (FDCs) were stopped, versus continuation with FDCs
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Health Economics Review
- Online Date
- September 2012
- Online ISSN
- Additional Links
- Fixed-dose combination
- Author Affiliations
- 1. Department of Internal Medicine, Son LLàtzer Hospital, Ctra. Manacor km 4, Palma de Mallorca, 07198, Spain
- 2. Pharmacoeconomics and Outcomes Research Iberia (PORIB), Calle de la Golondrina, 40A, Madrid, 28023, Spain
- 3. Department of Epidemiology, Son Llàtzer Hospital, Ctra. Manacor km 4, Palma de Mallorca, 07198, Spain