Switching HIV Regimens Increases Costs Significantly

July 12, 2017

Switching first-line HIV treatment regimens increases costs significantly if not done because of clinical necessity, according to recent research in the Journal of Managed Care Pharmacy.

“ART regimen switching is a common approach for addressing virologic failure, but switching is also done in patients with sustained viral suppression to manage drug toxicity and interactions, improve adherence, or reduce costs,” Lisa Rosenblatt, MD, MPH, a researcher at Bristol-Myers Squibb, and colleagues wrote. “There is ample evidence that switching ART in virologically stable patients—for example, from boosted PIs to non-nucleoside reverse transcriptase inhibitors—can improve quality of life, reduce adverse effects, and improve metabolic profile while maintaining virologic control; however, ART switches can also be associated with new adverse events and even lead to worse clinical outcomes.”

The researchers conducted a retrospectively studied claims data for 6983 adult patients with HIV who initiated ART treatment regimens between 2007 and 2013. They compared 927 patients who switched regimens after at least 6 months of treatment to a matched population of 18,511 patients who did not switch regimens. During the study, 20 nonswitchers were matched to every patient who switched for comparison. They compared health care utilization and costs at baseline to after switching.

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Study results showed that patients who switch regimens incurred greater health care cost, even after potential cofounders were adjusted for, compared with patients who did not switch. They found that health care costs for switchers were $37,120, compared with $31,771 for patients who did not switch (P < .05). Health care costs were found to be 8.9% higher among switchers. The researchers noted that higher costs were primarily driven by higher pharmacy costs.

Furthermore, patients who switched had higher health care utilization, according to the study. Researchers found that ambulatory visits and emergency department visits were greater among patients who switched regimens.

“Patients with HIV who switched regimens after having been stable on their first-line ART had significantly higher downstream costs than those who did not switch. The observed health care cost increases were driven mostly by higher HIV-related pharmacy costs,” Dr Rosenblatt and colleagues concluded. “Our findings suggest that ART switches among stable patients may be costly and should be undertaken only when clinically warranted.”

David Costill