Health Outcomes and Policy Research, Department of Pharmaceutical Sciences, University of Tennessee College of Pharmacy, 847 Monroe Ave., Memphis, TN 38163, USA.
Res Social Adm Pharm. 2012 Mar-Apr;8(2):157-65. doi: 10.1016/j.sapharm.2010.12.004. Epub 2011 Jun 28.
Combining various antiretroviral agents into one single dosage form has been a strategy to reduce pill burden and enhance medication adherence among human immunodeficiency virus /AIDS (HIV/AIDS) patients.
This is a cost-utility study from a health care system's perspective comparing coformulated fixed dose (FXD) strategy versus multiple free dose combination (FRC) in antiretroviral therapy.
The Medical Expenditure Panel Survey (MEPS) was used to identify HIV/AIDS patients with ≥2 active antiretroviral medications. Patients on FXD were matched in 1:1 ratio with the FRC group using propensity scores. All medical costs excluding those paid by patients and families were included. Utility was measured using SF-6D scores from the SF-12 questionnaire. Incremental cost-utility ratios (ICURs) were calculated using the mean annual estimates. A cost-effectiveness acceptability curve was determined using a Monte Carlo probabilistic simulation technique.
Nine FXD antiretroviral formulations approved by the U.S. Food and Drug Administration by 2005 was included in this study. One hundred seventy HIV/AIDS patients with ≥2 antiretroviral agents were identified from the MEPS database, of which 53% (n=92) were on FXD formulation. On matching, 70 patients from FXD had a match from the FRC group. No differences in sociodemographic and health status variables were observed between the matched groups. The mean annual cost was $15,766.15 for FXD patients and $11,875.21 for FRC patients. The mean utility gained by using FXD over FRC was 0.085; however, this difference was not statistically significant. The ICUR for the FXD treatment over FRC treatment was $45,540.49/quality-adjusted life years (QALYs). Probabilistic sensitivity analysis showed FXD to dominate FRC (>50% probability of being cost-effective) above the $40,000 threshold.
Although the cost-effectiveness of a single-pill strategy was within the acceptable willingness-to-pay threshold, the QALY difference were minimal. Further research is recommended to explore the long-term impact of the strategy.
将各种抗逆转录病毒药物组合成一种单一剂量形式是一种策略，可以减少艾滋病病毒/艾滋病（HIV/AIDS）患者的用药负担并提高药物依从性。
本项从医疗保健系统的角度出发，比较了固定剂量复方（FXD）策略与多种自由剂量组合（FRC）在抗逆转录病毒治疗中的成本效用。
使用医疗支出面板调查（MEPS）来确定至少有 2 种活性抗逆转录病毒药物的 HIV/AIDS 患者。使用倾向评分对 FXD 患者进行 1:1 比例的匹配，与 FRC 组进行匹配。包括除患者和家庭支付的费用以外的所有医疗费用。使用 SF-12 问卷中的 SF-6D 评分来衡量效用。使用平均年度估计值计算增量成本效用比（ICUR）。使用蒙特卡罗概率模拟技术确定成本效益接受曲线。
本研究纳入了美国食品和药物管理局（FDA）在 2005 年之前批准的 9 种 FXD 抗逆转录病毒制剂。从 MEPS 数据库中确定了 170 名至少有 2 种抗逆转录病毒药物的 HIV/AIDS 患者，其中 53%（n=92）使用 FXD 制剂。通过匹配，从 FXD 组中找到了 70 名患者的匹配。匹配组之间在社会人口统计学和健康状况变量方面没有差异。FXD 患者的平均年度费用为 15766.15 美元，FRC 患者的平均年度费用为 11875.21 美元。使用 FXD 获得的平均效用比 FRC 高 0.085，但差异无统计学意义。FXD 治疗相对于 FRC 治疗的 ICUR 为 45540.49 美元/质量调整生命年（QALY）。概率敏感性分析表明，在 40000 美元的阈值以上，FXD 治疗优于 FRC 治疗（具有超过 50%的成本效益的概率）。
尽管单一药丸策略的成本效益在可接受的支付意愿范围内，但 QALY 的差异很小。建议进行进一步的研究以探索该策略的长期影响。
