Llibre Josep M, Cardona Gloria, Santos José R, Andreu Angels, Estrada Josep O, Ara Jordi, Bonafont Xavier, Clotet Bonaventura
HIV Unit, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain ; Lluita contra la SIDA Foundation, Badalona, Barcelona, Spain.
Clinicoecon Outcomes Res. 2013 May 23;5:215-21. doi: 10.2147/CEOR.S43662. Print 2013.
The current economic recession in European countries has forced governments to design emergency measures to reduce spending on drugs, including antiretroviral therapy (ART). Switching antiretroviral drugs for others that have the same efficacy and safety profile at a lower cost (cost-reduction measures, CRM) could prove to be a valid means of generating savings.
Descriptive study of prospective consensus-based CRM undertaken in 2011 in a Catalonian hospital HIV unit among patients with prolonged plasma HIV-1 RNA <50 copies/mL.
During the study period, we made 673 switches (87.5% more than the previous year), of which 378 (56.2%) were CRM (16% of all patients treated), leading to a savings of €87,410/month. Switching tenofovir/emtricitabine for abacavir/lamivudine was the most common CRM (129, 31.3%), followed by simplification to boosted protease inhibitor monotherapy (bPImono, 102, 26%). The CRM that generated the greatest saving were switching to bPImono (38%), withdrawal or replacement of raltegravir (24%), switching tenofovir/emtricitabine for abacavir/lamivudine (13%), and switching to nevirapine (5%). Cost savings with CRM were slightly higher than those achieved with medication paid for by clinical trial sponsors (€80,333/month) or through discount arrangements (€76,389/month).
Proactively switching antiretroviral therapy in selected treated patients with sustained virological suppression can generate significant cost savings in pharmacy spending in developed countries. These findings have implications for decision makers in designing safe strategies that maintain HIV-1 suppression at lower costs.
欧洲国家当前的经济衰退迫使各国政府制定紧急措施以削减药品开支，其中包括抗逆转录病毒疗法（ART）。将抗逆转录病毒药物换用其他疗效和安全性相同但成本更低的药物（成本削减措施，CRM）可能是实现节约的有效手段。
2011年在加泰罗尼亚一家医院的艾滋病毒科室对血浆HIV-1 RNA持续<50拷贝/毫升的患者进行了基于前瞻性共识的CRM描述性研究。
在研究期间，我们进行了673次换药（比上一年多87.5%），其中378次（56.2%）为CRM（占所有接受治疗患者的16%），每月节省87,410欧元。用阿巴卡韦/拉米夫定替换替诺福韦/恩曲他滨是最常见的CRM（129次，31.3%），其次是简化为增强型蛋白酶抑制剂单一疗法（bPImono，102次，26%）。节省最多的CRM是换用bPImono（38%）、停用或替换雷特格韦（24%）、用阿巴卡韦/拉米夫定替换替诺福韦/恩曲他滨（13%）以及换用奈韦拉平（5%）。CRM节省的成本略高于临床试验赞助商支付的药物（每月80,333欧元）或通过折扣安排节省的成本（每月76,389欧元）。
在选定的病毒得到持续抑制的接受治疗患者中主动更换抗逆转录病毒疗法可在发达国家显著节省药房开支。这些发现对决策者设计以更低成本维持HIV-1抑制的安全策略具有启示意义。
