Papot Emmanuelle, Landman Roland, Louni Françoise, Charpentier Charlotte, Peytavin Gilles, Certain Agnès, Fradet Clémence, Castro Daniela R, Preau Marie, Goujard Cécile, Yeni Patrick, Yazdanpanah Yazdan
aIAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité bInfectious Diseases Clinic, Bichat-Claude Bernard University Hospital, AP-HP cCOREVIH Ile De France Nord, Paris dVirology Department, Bichat-Claude Bernard University Hospital, AP-HP ePharmaco-Toxicology Department, Bichat-Claude Bernard University Hospital, AP-HP fPharmacy/Patient Education Program on ART, Bichat-Claude Bernard University Hospital, AP-HP, Paris gAIDES, Paris hInstitute of Psychology - Lumière Lyon 2 University, GRePS - EA 4163, Bron iInternal Medicine, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre jINSERM U1018 - CESP, University Paris Sud, Le Kremlin-Bicêtre, France.
AIDS. 2017 Jun 1;31(9):1271-1279. doi: 10.1097/QAD.0000000000001467.
In this study, we first assessed costs associated with the use of antiretroviral therapy (ART) in an infectious diseases University Hospital Clinic; second, we evaluated characteristics associated with these costs and finally simulated the impact on the overall ART budget of switching first-line and second-line regimens to less-costly regimens (as effective and well tolerated).
Cohort analysis including persons living with HIV (PLHIV) aged at least 18 years on ART to estimate ART costs during 2014.
The current study was conducted in the Bichat-Claude Bernard University Hospital Clinic in Paris, France, where 4501 PLHIV consulted in 2014. We used the medical database Nadis to describe patients' ART, characteristics and estimated costs. When assessing the budgetary impact of potential switches, we considered patients' history of failure, CD4 cell count, plasma viral load, resistance mutations, hepatitis B surface antigen or HLAB5701 profile.
A total of 4238 of 4501 patients were on ART (94%). The total annual cost of ART prescribed was estimated at &OV0556;48 280 200 in 2014; first/second (simplification)-line regimens represented 25% (1076/4238) of the treated PLHIV and 23% (&OV0556;11 209 000) of the annual cost. For these PLHIV, we considered switches from the most common ART regimens (protease inhibitor boosted by ritonavir or nonnucleoside reverse transcriptase inhibitor + two nucleoside reverse transcriptase inhibitors) to less-expensive regimens. We found savings ranging from &OV0556;36 100 to 1472 600/year. Savings were the highest when we considered switching to generic-based regimens or from protease inhibitor-based triple therapy to protease inhibitor monotherapy.
Costs associated with ART prescriptions are very high. Switches to generic-based regimens are associated with large savings. However, those targeting protease inhibitor regimens are also associated with substantial savings and should be considered.
在本研究中，我们首先评估了一所传染病大学医院诊所使用抗逆转录病毒疗法（ART）的相关成本；其次，我们评估了与这些成本相关的特征，最后模拟了将一线和二线治疗方案转换为成本更低的方案（同样有效且耐受性良好）对ART总体预算的影响。
队列分析，纳入年龄至少18岁且正在接受ART治疗的艾滋病毒感染者（PLHIV），以估算2014年的ART成本。
本研究在法国巴黎的比夏-克劳德·贝尔纳大学医院诊所进行，2014年有4501名PLHIV前来就诊。我们使用医疗数据库Nadis来描述患者的ART治疗情况、特征并估算成本。在评估潜在转换的预算影响时，我们考虑了患者的治疗失败史、CD4细胞计数、血浆病毒载量、耐药突变、乙肝表面抗原或HLAB5701特征。
4501名患者中有4238名（94%）正在接受ART治疗。2014年ART处方的年度总成本估计为48280200欧元；一线/二线（简化）治疗方案占接受治疗的PLHIV的25%（1076/4238），占年度成本的23%（11209000欧元）。对于这些PLHIV，我们考虑从最常用的ART方案（利托那韦增强的蛋白酶抑制剂或非核苷类逆转录酶抑制剂+两种核苷类逆转录酶抑制剂）转换为成本更低的方案。我们发现每年节省的费用在36100欧元至1472600欧元之间。当考虑转换为基于仿制药的方案或从基于蛋白酶抑制剂的三联疗法转换为蛋白酶抑制剂单药治疗时，节省的费用最高。
ART处方相关成本非常高。转换为基于仿制药的方案可节省大量费用。然而，针对蛋白酶抑制剂方案的转换也可节省大量费用，应予以考虑。
