Farr Amanda M, Johnston Stephen S, Ritchings Corey, Brouillette Matthew, Rosenblatt Lisa
a a Truven Health Analytics, Life Sciences , Cambridge , MA , USA.
b b Truven Health Analytics, Life Sciences , Bethesda , MD , USA.
J Med Econ. 2016;19(4):386-96. doi: 10.3111/13696998.2015.1128942. Epub 2015 Dec 29.
Atazanavir (ATV) and darunavir (DRV) are protease inhibitors approved for HIV treatment in combination with ritonavir (/r). The objectives of this study were to compare persistence (time to treatment discontinuation/modification), adherence, and healthcare costs among patients with human immunodeficiency virus (HIV) initiating ATV/r or DRV/r.
This retrospective cohort study used commercial and Medicaid administrative insurance claims data. Patients initiating ATV/r or DRV/r from 2006-2013 with continuous enrollment for ≥6 months before and ≥3 months after initiation were included. Patients were followed from initiation until discontinuation/modification (≥30 day gap in ATV or DRV or initiation of a new antiretroviral medication), during which time adherence (proportion of days covered [PDC], with PDC ≥80% or 95% considered adherent) and per-patient per-month (PPPM) total healthcare costs were measured. DRV/r patients were propensity score matched to ATV/r patients at a 1:1 ratio to achieve balance on potentially confounding demographic and clinical factors. Commercial and Medicaid samples were analyzed separately, as were antiretroviral (ART)-naïve and experienced patients.
The final samples comprised 2988 commercially-insured and 1158 Medicaid-insured patients. There were no significant differences in hazards of discontinuation/modification between the ATV/r or DRV/r cohorts. With respect to odds of being adherent, the only marginally significant result was comparing odds of achieving PDC ≥80% among ART-naïve Medicaid patients, which favored ATV/r. All other adherence comparisons were not significant. Although ATV/r cohorts tended to have lower PPPM costs, the majority of these differences were not statistically significant.
Patients with HIV treated with either ATV/r or DRV/r had similar time to treatment discontinuation/modification, adherence, and monthly healthcare costs. Results were similar across the pre-specified sub-groups. These findings are useful not only as an insight into clinical practice, but also as a resource for healthcare providers and payers evaluating treatment options for HIV+ individuals.
阿扎那韦（ATV）和达芦那韦（DRV）是经批准与利托那韦（/r）联合用于治疗HIV的蛋白酶抑制剂。本研究的目的是比较开始使用ATV/r或DRV/r的人类免疫缺陷病毒（HIV）患者的治疗持续时间（治疗中断/调整时间）、依从性和医疗费用。
这项回顾性队列研究使用了商业保险和医疗补助管理保险索赔数据。纳入2006年至2013年开始使用ATV/r或DRV/r且开始治疗前连续参保≥6个月、开始治疗后连续参保≥3个月的患者。从开始治疗到中断/调整（ATV或DRV中断≥30天或开始使用新的抗逆转录病毒药物）对患者进行随访，在此期间测量依从性（覆盖天数比例[PDC]，PDC≥80%或95%被视为依从）和患者每月总医疗费用。DRV/r组患者与ATV/r组患者按1:1的比例进行倾向评分匹配，以在潜在混杂的人口统计学和临床因素上达到平衡。分别对商业保险和医疗补助样本以及初治和经治抗逆转录病毒（ART）患者进行分析。
最终样本包括2988名商业保险患者和1158名医疗补助保险患者。ATV/r组和DRV/r组之间的中断/调整风险没有显著差异。关于依从性的几率，唯一具有微弱显著意义的结果是比较初治医疗补助患者中达到PDC≥80%的几率，该结果更倾向于ATV/r。所有其他依从性比较均无显著差异。尽管ATV/r组的患者每月总费用往往较低，但这些差异中的大多数在统计学上并不显著。
接受ATV/r或DRV/r治疗的HIV患者在治疗中断/调整时间、依从性和每月医疗费用方面相似。在预先指定的亚组中结果相似。这些发现不仅有助于深入了解临床实践，也为医疗服务提供者和支付方评估HIV感染者的治疗选择提供了参考。
