Southern Alberta Clinic, Calgary, AB, Canada.
Department of Medicine, University of Calgary, Calgary, AB, Canada.
HIV Med. 2018 Apr;19(4):290-298. doi: 10.1111/hiv.12578. Epub 2018 Jan 25.
The incremental costs of expanding antiretroviral (ARV) drug treatment to all HIV-infected patients are substantial, so cost-saving initiatives are important. Our objectives were to determine the acceptability and financial impact of de-simplifying (i.e. switching) more expensive single-tablet formulations (STFs) to less expensive generic-based multi-tablet components. We determined physician and patient perceptions and acceptance of STF de-simplification within the context of a publicly funded ARV budget.
Programme costs were calculated for patients on ARVs followed at the Southern Alberta Clinic, Canada during 2016 (Cdn$). We focused on patients receiving Triumeq® and determined the savings if patients de-simplified to eligible generic co-formulations. We surveyed all prescribing physicians and a convenience sample of patients taking Triumeq® to see if, for budgetary purposes, they felt that de-simplification would be acceptable.
Of 1780 patients receiving ARVs, 62% (n = 1038) were on STF; 58% (n = 607) of patients on STF were on Triumeq®. The total annual cost of ARVs was $26 222 760. The cost for Triumeq® was $8 292 600. If every patient on Triumeq® switched to generic abacavir/lamivudine and Tivicay® (dolutegravir), total costs would decrease by $4 325 040. All physicians (n = 13) felt that de-simplifying could be safely achieved. Forty-eight per cent of 221 patients surveyed were agreeable to de-simplifying for altruistic reasons, 27% said no, and 25% said maybe.
De-simplifying Triumeq® generates large cost savings. Additional savings could be achieved by de-simplifying other STFs. Both physicians and patients agreed that selective de-simplification was acceptable; however, it may not be acceptable to every patient. Monitoring the medical and cost impacts of de-simplification strategies seems warranted.
扩大抗逆转录病毒（ARV）药物治疗范围以覆盖所有 HIV 感染者所需的增量成本巨大，因此节省成本的措施非常重要。我们的目的是确定简化（即转换）更昂贵的单片制剂（STF）为更便宜的基于通用药物的多片药物组合以节省成本的可接受性和财务影响。我们在公共资助的 ARV 预算背景下确定了医生和患者对 STF 简化的看法和接受程度。
我们计算了 2016 年在加拿大南艾伯塔诊所接受 ARV 治疗的患者的项目成本（加元）。我们专注于接受 Triumeq®的患者，并确定如果患者简化为符合条件的通用组合药物，将节省多少费用。我们调查了所有开具处方的医生和接受 Triumeq®的方便样本患者，以了解从预算角度来看，他们是否认为简化是可以接受的。
在接受 ARV 治疗的 1780 名患者中，62%（n=1038）接受 STF；58%（n=607）接受 STF 的患者服用 Triumeq®。ARV 的年总成本为 26222760 加元。Triumeq®的成本为 8292600 加元。如果每个服用 Triumeq®的患者都改用通用的阿巴卡韦/拉米夫定和 Tivicay®（度鲁特韦），总费用将减少 4325040 加元。所有 13 名医生（n=13）都认为简化可以安全实现。在接受调查的 221 名患者中，48%的人出于利他主义原因愿意简化，27%的人表示不同意，25%的人表示可能。
简化 Triumeq®可节省大量成本。通过简化其他 STF 还可以节省更多成本。医生和患者都同意选择性简化是可以接受的；然而，并非每个患者都能接受。似乎有必要监测简化策略的医疗和成本影响。
