Program for HIV Prevention and Treatment, Institut de Recherche pour le Développement IRD UMI 174-PHPT, France.
J Acquir Immune Defic Syndr. 2013 Sep 1;64(1):95-102. doi: 10.1097/QAI.0b013e318298a309.
As antiretroviral treatment (ART) programs mature, data on drug utilization and costs are needed to assess durability of treatments and inform program planning.
Children initiating ART were followed up in an observational cohort in Thailand. Treatment histories from 1999 to 2009 were reviewed. Treatment changes were categorized as: drug substitution (within class), switch across drug class (non nucleoside reverse-transcriptase inhibitors (NNRTI) to/from protease inhibitor (PI)), and to salvage therapy (dual PI or PI and NNRTI). Antiretroviral drug costs were calculated in 6-month cycles (US$ 2009 prices). Predictors of high drug cost including characteristics at start of ART (baseline), initial regimen, treatment change, and duration on ART were assessed using mixed-effects regression models.
Five hundred seven children initiated ART with a median 54 (interquartile range, 36-72) months of follow-up. Fifty-two percent had a drug substitution, 21% switched across class, and 2% to salvage therapy. When allowing for drug substitution, 78% remained on their initial regimen. Mean drug cost increased from $251 to $428 per child per year in the first and fifth year of therapy, respectively. PI-based and salvage regimens accounted for 16% and 2% of treatments prescribed and 33% and 5% of total costs, respectively. Predictors of high cost include baseline age ≥ 8 years, non nevirapine-based initial regimen, switch across drug class, and to salvage regimen (P < 0.005).
At 5 years, 21% of children switched across drug class and 2% received salvage therapy. The mean drug cost increased by 70%. Access to affordable second- and third-line drugs is essential for the sustainability of treatment programs.
随着抗逆转录病毒治疗（ART）项目的成熟，需要有关药物利用和成本的数据来评估治疗的持久性并为规划项目提供信息。
在泰国的一个观察性队列中对开始接受 ART 的儿童进行随访。回顾了 1999 年至 2009 年的治疗史。将治疗变化分为：药物替代（同类药物内）、跨药物类别（非核苷类逆转录酶抑制剂（NNRTI）与蛋白酶抑制剂（PI）之间的转换）和挽救治疗（双重 PI 或 PI 和 NNRTI）。按照 6 个月周期（2009 年美元价格）计算抗逆转录病毒药物成本。使用混合效应回归模型评估包括 ART 起始时（基线）的特征、初始方案、治疗变化以及 ART 持续时间在内的高药物成本的预测因素。
507 名儿童开始接受 ART 治疗，中位随访时间为 54（四分位距，36-72）个月。52%的儿童进行了药物替代，21%的儿童跨类别转换，2%的儿童进行了挽救治疗。如果允许药物替代，78%的儿童仍使用初始方案。第一年和第五年的治疗药物成本分别从每位儿童每年 251 美元增加到 428 美元。基于 PI 的方案和挽救方案分别占处方的 16%和 2%，分别占总费用的 33%和 5%。高成本的预测因素包括基线年龄≥8 岁、非奈韦拉平为基础的初始方案、跨药物类别转换和挽救方案（P<0.005）。
5 年内，21%的儿童跨药物类别转换，2%的儿童接受挽救治疗。药物成本平均增加了 70%。获得负担得起的二线和三线药物对于治疗项目的可持续性至关重要。
