OptumInsight Inc. - Health Economics and Outcomes Research , Eden Prairie , MN , USA.
Merck and Co Inc. - Center for Observational and Real World Evidence , Kenilworth , NJ , USA.
Curr Med Res Opin. 2019 Nov;35(11):1945-1953. doi: 10.1080/03007995.2019.1644850. Epub 2019 Aug 22.
This study compared healthcare utilization and costs associated with switching the first-line protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) based antiretroviral (ARV) regimen due to reasons other than virologic failure among patients with HIV-1. This was a retrospective analysis of commercial and Medicare Advantage with Part D enrollees in two US administrative claims databases. The study population comprised adults with HIV-1 infection initiating antiretroviral therapy (ART) on PI- or NNRTI-containing regimens from 1 January 2006 to 31 December 2015. Patients with a subsequent change in anchor agent were assigned to the switch cohort; the non-switch cohort was constructed using propensity score matching of three non-switching patients for each patient in the switch cohort. Patient characteristics and per patient per month healthcare resource utilization and costs were compared between the cohorts during the pre-switch, switch (15 days before and after switching) and post-switch periods. Costs during the switch period were also estimated with a multivariable-adjusted model. The matched study population consisted of 1204 patients who switched their first-line PI- or NNRTI-based regimen and 3612 patients who did not. Compared with the non-switch cohort, patients who switched had higher healthcare resource utilization during the pre-switch, switch and post-switch periods. Mean unadjusted non-ART costs in the switch cohort were nearly double ($2944 versus $1530, .001), more than double ($2562 versus $1215, .001) and 1.5 times higher ($1473 versus $968, .001) than costs in the non-switch cohort in the pre-switch, switch and post-switch periods, respectively. Patients with HIV-1 who initiated PI- or NNRTI-based regimens and switched ARTs for reasons other than virologic failure used more healthcare resources and incurred greater costs relative to patients in the non-switch cohort. This study highlights the importance of initiating patients on appropriate first-line ART to avoid the need to switch due to reasons other than virologic failure.
本研究比较了因病毒学失败以外的原因而更换一线蛋白酶抑制剂（PI）或非核苷类逆转录酶抑制剂（NNRTI）抗逆转录病毒（ARV）方案的 HIV-1 患者的医疗保健利用和相关成本。这是对两个美国行政索赔数据库中商业保险和医疗保险优势计划中接受 PI 或 NNRTI 方案的 HIV-1 感染者进行的回顾性分析。研究人群包括自 2006 年 1 月 1 日至 2015 年 12 月 31 日接受 PI 或 NNRTI 方案的抗逆转录病毒治疗（ART）的成人艾滋病毒 1 型感染者。随后改变主要药物的患者被分配到转换队列；非转换队列是通过将转换队列中的每位患者与三名非转换患者进行倾向评分匹配而构建的。在转换前、转换期间（转换前后 15 天）和转换后期间，比较了两组患者的患者特征和每月每位患者的医疗资源利用和费用。还使用多变量调整模型估计了转换期间的成本。 匹配后的研究人群包括 1204 名更换一线 PI 或 NNRTI 方案的患者和 3612 名未更换的患者。与非转换队列相比，转换组患者在转换前、转换和转换后期间的医疗资源利用更高。调整后的非 ART 费用，转换队列的费用接近两倍（2944 美元与 1530 美元，.001），几乎两倍（2562 美元与 1215 美元，.001）和 1.5 倍（1473 美元与 968 美元，.001），分别高于非转换队列的费用在转换前、转换和转换后期间。因病毒学失败以外的原因而开始使用 PI 或 NNRTI 方案并更换 ARTs 的 HIV-1 患者与非转换队列患者相比，使用了更多的医疗资源，产生了更高的费用。本研究强调了为避免因病毒学失败以外的原因而需要转换而开始为患者使用适当的一线 ART 的重要性。
