Abstract
Background/Aim of the StudyThe study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART,-regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios.MethodsAntiretroviral regimens (ART) from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART,-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC)-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes.ResultsDuring the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70). Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively). Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%.ConclusionsAnalysis of the data of this nationwide study reflects disease-specific health services research and will give insights into the cost impacts of antiretroviral therapy, and might allow a more rational allocation of resources within the German health care system.
Highlights
The implementation of combined antiretroviral therapy, cART, as the standard of care since the middle 1990s has substantially reduced morbidity and mortality in HIV-infected individuals [1,2], leading to decades of gain in life expectancy for these individuals, comparable to the normal age-matched population in industrialized countries [3]
Recent standard treatment guidelines recommend cART regimens in treatment-naive patients consisting of two nucleoside analogues (nRTI, and, in addition, a non-nucleoside reverse transcriptase inhibitor (NNRTI), a ritonavir-boosted protease inhibitor (PI/r) or, more recently, an integrase strand transfer inhibitor (INSTI) [4,5,6]
ClinSurv Cohort were enrolled in the study during the period of January 1st 1996 to December 31st 2008
Summary
The implementation of combined antiretroviral therapy, cART, as the standard of care since the middle 1990s has substantially reduced morbidity and mortality in HIV-infected individuals [1,2], leading to decades of gain in life expectancy for these individuals, comparable to the normal age-matched population in industrialized countries [3]. Prices of antiretroviral drugs in Germany are high – even in comparison to other industrialized countries – due to national specifics of the pharmaceutical market. Remarkable differences in national drug prices were found during an international survey [8], but the authors did not necessarily see a correlation between purchase volume and drug prices. The authors hypothesized that the availability of generic drugs next to branded drugs in the same market would lead to a reduction in prices
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