ViiV Healthcare, NC, USA.
Analysis Group, Inc., Boston, MA, USA.
J Med Econ. 2021 Jan-Dec;24(1):1204-1211. doi: 10.1080/13696998.2021.1995868.
Single-tablet regimens (STRs) can improve antiretroviral therapy (ART) adherence; however, the relationship between long-term adherence and patient healthcare resource utilization (HRU) is unclear. The objective of this study was to assess long-term ART adherence among people living with HIV (PLHIV) using STRs and multi-tablet regimens (MTRs) and compare HRU over time by adherence.
This retrospective study analyzed medical and pharmacy claims (Optum Clinformatics Data Mart Database). Included PLHIV were aged ≥18 years, had ≥1 medical claim with an HIV diagnosis, and had pharmacy claims for a complete STR or MTR. Adherence was analyzed as the proportion of days covered (PDC), stratified as ≥95%, very high; 90-95%, high; 80-90%, moderate; <80%, low. Cumulative all-cause and HIV-related HRU were calculated across 4 years. Among PLHIV with ≥4-year follow-up, HRU was assessed by adherence.
Among 15,153 PLHIV included, 63% achieved PDC ≥90% during Year 1. Among the subgroup of PLHIV with ≥4-year follow-up ( = 3,818), the proportion maintaining PDC ≥90% fell from 67% in Year 1 to 54% by Year 4. The difference from Years 1 to 4 in the proportion of PLHIV with PDC ≥90% was 13% and 17% in the STR and MTR groups, respectively. Cumulative HRU across the 4-year follow-up was higher in PLHIV with low vs high adherence (27% with low adherence had ≥1 emergency room visit vs 17% for very high, < .0001; 15% with low adherence had ≥1 inpatient stay vs 7% for very high, < .0001).
ART adherence showed room for improvement, particularly over the long term. PLHIV receiving STRs exhibited higher adherence vs those receiving MTRs; this difference increased over time. The proportion of PLHIV with higher HRU was significantly higher among those with lower adherence and became greater over time. Interventions and alternative therapies to improve adherence among PLHIV should be explored.
单一片剂治疗方案（STR）可提高抗逆转录病毒治疗（ART）的依从性；然而，长期依从性与患者的医疗保健资源利用（HRU）之间的关系尚不清楚。本研究的目的是评估使用 STR 和多片治疗方案（MTR）的 HIV 感染者（PLHIV）的长期 ART 依从性，并按依从性比较随时间推移的 HRU。
这是一项回顾性研究，分析了医疗和药房索赔（Optum Clinformatics Data Mart Database）。纳入的 PLHIV 年龄≥18 岁，有≥1 次医疗索赔并伴有 HIV 诊断，且有完整 STR 或 MTR 的药房索赔。依从性分析为比例覆盖天数（PDC），分层为≥95%，非常高；90-95%，高；80-90%，中；<80%，低。在 4 年内计算了所有原因和 HIV 相关的 HRU 的总和。在有≥4 年随访的 PLHIV 中，根据依从性评估 HRU。
在纳入的 15153 名 PLHIV 中，63%在第 1 年达到 PDC≥90%。在有≥4 年随访的 PLHIV 亚组（n=3818）中，维持 PDC≥90%的比例从第 1 年的 67%降至第 4 年的 54%。在 STR 和 MTR 组中，从第 1 年到第 4 年，PDC≥90%的 PLHIV 比例分别下降了 13%和 17%。在 4 年的随访中，低依从性组的 PLHIV 累积 HRU 高于高依从性组（27%低依从性的 PLHIV 至少有 1 次急诊就诊，而 17%高依从性的 PLHIV 至少有 1 次住院治疗，<.0001；15%低依从性的 PLHIV 至少有 1 次住院治疗，而 7%高依从性的 PLHIV 至少有 1 次住院治疗，<.0001）。
ART 依从性仍有改善空间，特别是在长期。接受 STR 的 PLHIV 与接受 MTR 的 PLHIV 相比，其依从性更高；而且这种差异随着时间的推移而增加。在较低依从性的 PLHIV 中，HRU 较高的 PLHIV 比例明显较高，且随着时间的推移，该比例逐渐增加。应探索提高 PLHIV 依从性的干预措施和替代疗法。
