[Costs and adherence to antiretroviral treatment].
Author(s): Ventura-Cerda JM, Ayago-Flores D, Vicente-Escrig E, Molla-Cantavella S, Alos-Alminana M
Affiliation(s): Servicio de Farmacia, Hospital General de Castellon, Castellon, Spain. ventura_jma@gva.es
Publication date & source: 2010-11, Farm Hosp., 34(6):284-92. Epub 2010 Aug 7.
Publication type: English Abstract
OBJECTIVE: To develop a system of data management that allows us to estimate the comparative effectiveness of the various antiretroviral treatment (ART) regimens. METHOD: Retrospective observational study in patients infected with HIV with stable ART. Adherence to treatment and unit cost for each patient's treatment was determined. The cost/patient/day was calculated and, multiplying by an adherence factor (fADH), the (cost/patient/day)(ADH). The comparison of both allowed us to obtain the Deltacost/patient, which estimates the additional costs caused by lack of adherence. The incremental cost-effectiveness (iCER), grouping the results by the various coformulated drugs ("combos"). A study of the budgetary impact of these combos was carried out. RESULTS: 468 patients were evaluated (62% adherent). Average adherence was 88+/-18%. The average value of (cost/patient/day) (ADH) was significantly higher than the cost/patient/day (27.3+/-9.8euro compared to 24.3+/-7.6euro. p<0.001). Just as with the f(ADH), no differences were found in the Deltacost/patient between the different ART combinations. The combo with the least deviation from the cost/patient/day due to lack of adherence was that composed of abacavir/zedovudine/lamivudine (ABC/AZT/3TC,Deltacost/patient=8.72+/-14.18%), and that with the greatest deviation AZT/3TC (Deltacost/patient=13.52+/-17.68%). No significant differences were found in the iCER calculated for any combo. The ART that included abacavir/lamivudine (ABC/3TC) obtained the least budgetary impact. CONCLUSIONS: The greatest cost and percentage of adherent patients associated with the combos composed of Tenovovir/Emtricitabine(TDF/FTC) and ABC/3TC, and the least cost and effectiveness of those composed of AZT/#TC and ABC/AZT/3TC, does not allow us to identify any option as significantly dominant. The regimens with ABC/3TC were shown to be the most favourable from the combined point of view of cost and adherence. Copyright (c) 2009 SEFH. Published by Elsevier Espana. All rights reserved.
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