Abstract
BackgroundThe possibility of incorporating generics into combination antiretroviral therapy and breaking apart once-daily single-tablet regimens (STRs), may result in less efficacious medications and/or more complex regimens with the expectation of marked monetary savings. A modeling approach that assesses the merits of such policies in terms of lifelong costs and health outcomes using adherence and effectiveness data from real-world U.S. settings.MethodsA comprehensive computer-based microsimulation model was developed to assess the lifetime health (life expectancy and quality adjusted life-years—QALYs) and economic outcomes in HIV-1 infected patients initiating STRs compared with multiple-table regimens including generic medications where possible (gMTRs). The STRs considered included tenofovir disoproxil fumarate/emtricitabine and efavirenz or rilpivirine or elvitegravir/cobicistat. gMTRs substitutions included each counterpart to STRs, including generic lamivudine for emtricitabine and generic versus branded efavirenz.ResultsLife expectancy is estimated to be 1.301 years higher (discounted 0.619 QALY gain) in HIV-1 patients initiating a single-tablet regimen in comparison to a generic-based multiple-table regimen. STRs were associated with an average increment of $26,547.43 per patient in medication and $1,824.09 in other medical costs due to longer survival which were partially offset by higher inpatients costs ($12,035.61) with gMTRs treatment. Overall, STRs presented incremental lifetime costs of $16,335.91 compared with gMTRs, resulting in an incremental cost-effectiveness ratio of $26,383.82 per QALY gained.ConclusionsSTRs continue to represent good value for money under contemporary cost-effectiveness thresholds despite substantial price reductions of generic medications in the U. S.
Highlights
Innovations in antiretroviral therapy (ART) have dramatically altered the natural history of HIV infection, transforming it into a manageable chronic disease [1]
A comprehensive computer-based microsimulation model was developed to assess the lifetime health and economic outcomes in HIV-1 infected patients initiating singletablet regimen (STR) compared with multiple-table regimens including generic medications where possible
STRs were associated with an average increment of $26,547.43 per patient in medication and $1,824.09 in other medical costs due to longer survival which were partially offset by higher inpatients costs ($12,035.61) with generic medications where possible (gMTRs) treatment
Summary
Innovations in antiretroviral therapy (ART) have dramatically altered the natural history of HIV infection, transforming it into a manageable chronic disease [1]. ART has markedly increased survival in people living with HIV (PLH) and extended life expectancy such that there are little differences between those with and without HIV [2]. Delayed access to treatment and suboptimal ART adherence crucially influence poor outcomes, including the increased risk of hospitalization and death [4]. One strategy is the incorporation of generic medications into ART regimens as soon as they become available. That has led to suggestions of potentially including less efficacious drugs as well as more complex regimens under the expectation of monetary savings [7]. The possibility of incorporating generics into combination antiretroviral therapy and breaking apart once-daily single-tablet regimens (STRs), may result in less efficacious medications and/or more complex regimens with the expectation of marked monetary savings. A modeling approach that assesses the merits of such policies in terms of lifelong costs and health outcomes using adherence and effectiveness data from real-world U.S settings.
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