Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands.
Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, The Netherlands.
PLoS One. 2024 Jul 26;19(7):e0307963. doi: 10.1371/journal.pone.0307963. eCollection 2024.
HIV treating physicians in the Netherlands follow the guidelines of the Department of Health and Human Services (DHHS). Most of these recommended initial regimens are single-tablet regimens (STRs), which incur higher costs. By the end of 2017, generic NRTI backbones had become widely available, offering a potentially cheaper multi-tablet regimen. This study aimed to evaluate guideline compliance in people with HIV who started antiretroviral therapy (ART), the uptake of generic multi-tablet regimens (gMTRs), and associated medication costs.
This retrospective cohort study used data from the Dutch HIV Monitoring Foundation to determine the proportion of treatment-naïve people entering care who initiated ART according to the DHHS and type of ART regimens prescribed between January 2016 and December 2020. We analyzed ART prescriptions, both at the national level and per individual HIV treatment centers. We calculated the monthly ART costs based on Dutch medicine prices listed on www.medicijnkosten.nl for each calendar year.
In 2016, an integrase inhibitor-containing regimen was initiated in 77.3% which increased to 87.8% in 2020. The compliance rate to DHHS-recommended initial regimens ranged from 82.8% in 2016 to 90.9% in 2020. Most patients received single-tablet regimens, 81.3% in 2016 to 60.3% in 2020. After the introduction the gMTRs showed a steady increase from 17.8% in 2018 to 37.8% in 2020. The cost of the first-line regimen per patient decreased by 22.9% in 2020 compared with 2017. The decrease was larger in centers where treatment-naïve individuals with HIV were preferentially initiated on a gMTR.
There was a high compliance to the "DHHS-recommended initial regimens for most people with HIV" in the Netherlands. Most people who initiated ART received STRs, although the percentage of people who started on STRs gradually decreased over time. The use of gMTRs increased over time and was associated with lower medication costs.
荷兰的 HIV 治疗医生遵循美国卫生与公众服务部 (DHHS) 的指南。这些建议的初始方案大多是单片方案 (STRs)，费用较高。到 2017 年底，通用 NRTI 骨干药物已广泛可用，提供了一种潜在更便宜的多片方案。本研究旨在评估开始抗逆转录病毒治疗 (ART) 的 HIV 感染者的指南依从性、通用多片方案 (gMTRs) 的采用情况以及相关药物费用。
本回顾性队列研究使用荷兰 HIV 监测基金会的数据，确定 2016 年 1 月至 2020 年 12 月期间进入护理的治疗初治人群中，根据 DHHS 以及所开 ART 方案的类型，开始接受 ART 的比例。我们分析了国家层面和每个 HIV 治疗中心的 ART 处方。我们根据每个日历年度在 www.medicijnkosten.nl 上列出的荷兰药品价格计算了每月的 ART 费用。
2016 年，含有整合酶抑制剂的方案的起始率为 77.3%，到 2020 年增加到 87.8%。DHHS 推荐的初始方案的依从率从 2016 年的 82.8%到 2020 年的 90.9%。大多数患者接受单片方案，从 2016 年的 81.3%到 2020 年的 60.3%。gMTR 推出后，从 2018 年的 17.8%稳步上升到 2020 年的 37.8%。与 2017 年相比，2020 年每位患者的一线方案费用降低了 22.9%。在优先使用 gMTR 为 HIV 治疗初治患者的中心，降幅更大。
荷兰“DHHS 推荐的大多数 HIV 感染者初始方案”的依从率很高。大多数开始接受 ART 的人接受了 STRs，尽管随着时间的推移，接受 STRs 的人数百分比逐渐下降。gMTR 的使用随着时间的推移而增加，并与较低的药物费用相关。
