Pharmacoeconomics and Outcomes Research Iberia (PORIB), Calle de la Golondrina, 40A, Madrid, 28023, Spain.
Health Econ Rev. 2012 Sep 3;2(1):16. doi: 10.1186/2191-1991-2-16.
The lower sales price of generic lamivudine has caused healthcare administrators to consider abolishing fixed-dose antiretroviral combinations (FDCs) that contain lamivudine and emtricitabine. The alternative is to administer the individual components of the FDCs separately, thus incorporating the new generic lamivudine medication.
The Balearic Islands Health Service ordered the discontinuation of the treatment with FDCs in July 2010, but FDCs were reintroduced in August 2010. At that point, an independent, retrospective cost analysis was performed by Son Llàtzer Hospital. A total of 75 patients who were treated from July to August 2010 underwent replacement of their FDC treatment with the individual components. Additionally, 150 patients who continued using FDCs were randomly selected. For both patient groups, the antiretroviral therapy that was administered and the costs associated with management of adverse events were recorded. The study period used for the cost calculations was the average number of days that patients used separate components of FDCs (120 days). An alternative analysis was performed to consider the costs of the extra follow-up visit (consultation and clinical tests) that was required for patients who changed their antiretroviral therapy.
Considering antiretroviral therapies and adverse events, the administration of the separate components increased the total daily cost by 0.72 € per patient compared to treatment with FDCs. When the cost of an extra follow-up visit was considered, the daily cost increased by 3.61 € per patient.
Our study suggests that the discontinuation of FDC treatment and the replacement with the administration of separate antiretroviral agents could lead to an increase in healthcare costs due to the higher rate of adverse events that was observed with the discontinuation of FDCs.
由于通用拉米夫定的销售价格较低，医疗保健管理人员开始考虑取消包含拉米夫定和恩曲他滨的固定剂量复方抗逆转录病毒药物（FDC）。替代方案是分别给予 FDC 的各个成分，从而纳入新的通用拉米夫定药物。
2010 年 7 月，巴利阿里群岛卫生局下令停止使用 FDC 治疗，但在 2010 年 8 月又重新引入了 FDC。此时，Son Llàtzer 医院进行了一项独立的回顾性成本分析。共有 75 名在 2010 年 7 月至 8 月期间接受治疗的患者将其 FDC 治疗更换为各个成分。此外，随机选择了 150 名继续使用 FDC 的患者。对于这两组患者，记录了所给予的抗逆转录病毒治疗以及与不良事件管理相关的成本。成本计算所使用的研究期是患者使用 FDC 各个成分的平均天数（120 天）。还进行了替代分析，以考虑因改变抗逆转录病毒疗法而需要进行的额外随访就诊（咨询和临床检查）的费用。
考虑到抗逆转录病毒治疗和不良事件，与使用 FDC 相比，单独给予各成分会使每位患者的总日费用增加 0.72 欧元。当考虑额外随访就诊的费用时，每位患者的日费用增加了 3.61 欧元。
我们的研究表明，由于停止使用 FDC 治疗后观察到不良事件发生率更高，因此停止使用 FDC 并改用单独给予抗逆转录病毒药物可能会导致医疗保健成本增加。
