Lower Healthcare Costs Associated with the Use of a Single-Pill ARV Regimen in the UK, 2004–2008

Eduard J Beck,Stephen Taylor,Mike Youle,Anton Pozniak,Ian Williams,John Walsh,Brian Gazzard,Roshni Sangha,Sundhiya Mandalia,Mark Gompels,Ed Wilkins,Margaret Johnson,Ray Brettle,Achim Schwenk,Maarten Postma

doi:10.1371/journal.pone.0047376

Abstract

AimInvestigate the cost and effects of a single-pill versus two- or three pill first-line antiretroviral combinations in reducing viral load, increasing CD4 counts, and first-line failure rate associated with respective regimens at 6 and 12 months.MethodsPatients on first-line TDF+3TC+EFV, TDF+FTC+EFV, Truvada®+EFV or Atripla® between 1996–2008 were identified and viral load and CD4 counts measured at baseline, six and twelve months respectively. Factors that independently predicted treatment failure at six and twelve months were derived using multivariate Cox's proportional hazard regression analyses. Use and cost of hospital services were calculated at six and twelve months respectively.ResultsAll regimens reduced viral load to below the limit of detection and CD4 counts increased to similar levels at six and twelve months for all treatment regimens. No statistically significant differences were observed for rate of treatment failure at six and twelve months. People on Atripla® generated lower healthcare costs for non-AIDS patients at £5,340 (£5,254 to £5,426) per patient-semester and £9,821 (£9,719 to £9,924) per patient-year that was £1,344 (95%CI £1,222 to £1,465) less per patient-semester and £1,954 (95%CI £1,801 to £2,107) less per patient-year compared with Truvada®+EFV; healthcare costs for AIDS patients were similar across all regimens.ConclusionThe single pill regimen is as effective as the two- and three-pill regimens of the same drugs, but if started as first-line induction therapy there would be a 20% savings on healthcare costs at six and 17% of costs at twelve months compared with Truvada®+EFV, that generated the next lowest costs.

Highlights

Antiretroviral therapy (ART) has undergone remarkable development since the antiretroviral properties of AZT were first established in 1987 with the subsequent development of dual- and triple-therapy
The total number of patients who started on the four regimens was 1,448, of whom 25% had been diagnosed with AIDS (Table 1)
Among both groups of patients, the largest proportion had been started on AtriplaH, followed by TruvadaH+Efavirenz, TDF+3TC+EFV and least number of patients started on TDF+FTC+EFV

Summary

Introduction

Antiretroviral therapy (ART) has undergone remarkable development since the antiretroviral properties of AZT were first established in 1987 with the subsequent development of dual- and triple-therapy. One of the early problems that people living with HIV (PLHIV) had was the large pill burden associated with tripletherapy when first introduced into routine treatment and care in 1996. The association of lowered adherence with increased pill burden and poorer outcomes has been recognized for some time, in terms of number of pills to be taken and the frequency with which they have to be taken [1,2]. Various strategies have been developed over time to produce once-daily dose regimens, combining a number of different drugs into fewer tablets: ‘fixed-dose combinations’ (FDCs). In some FDCs different antiretroviral drugs (ARVs) are combined into one tablet that can be taken once-a-day and improves adherence [3,4,5,6]. Similar findings have recently been reported with the use of FDCs in the management of hypertension [7]

Objectives

Methods

Results

Conclusion