[Costs and adherence to antiretroviral treatment].
OBJECTIVE
To develop a system of data management that allows us to estimate the comparative effectiveness of the various antiretroviral treatment (ART) regimens.


METHODS
Retrospective observational study in patients infected with HIV with stable ART. Adherence to treatment and unit cost for each patient's treatment was determined. The cost/patient/day was calculated and, multiplying by an adherence factor (fADH), the (cost/patient/day)(ADH). The comparison of both allowed us to obtain the Δcost/patient, which estimates the additional costs caused by lack of adherence. The incremental cost-effectiveness (iCER), grouping the results by the various coformulated drugs ("combos"). A study of the budgetary impact of these combos was carried out.


RESULTS
468 patients were evaluated (62% adherent). Average adherence was 88±18%. The average value of (cost/patient/day) (ADH) was significantly higher than the cost/patient/day (27.3±9.8€ compared to 24.3±7.6€. p<0.001). Just as with the f(ADH), no differences were found in the Δcost/patient between the different ART combinations. The combo with the least deviation from the cost/patient/day due to lack of adherence was that composed of abacavir/zedovudine/lamivudine (ABC/AZT/3TC,Δcost/patient=8.72±14.18%), and that with the greatest deviation AZT/3TC (Δcost/patient=13.52±17.68%). No significant differences were found in the iCER calculated for any combo. The ART that included abacavir/lamivudine (ABC/3TC) obtained the least budgetary impact.


CONCLUSIONS
The greatest cost and percentage of adherent patients associated with the combos composed of Tenovovir/Emtricitabine(TDF/FTC) and ABC/3TC, and the least cost and effectiveness of those composed of AZT/#TC and ABC/AZT/3TC, does not allow us to identify any option as significantly dominant. The regimens with ABC/3TC were shown to be the most favourable from the combined point of view of cost and adherence.
Ventura-Cerdá
J M
JM
Servicio de Farmacia, Hospital General de Castellón, Castellón, Spain. ventura_jma@gva.es
Ayago-Flores
D
D
Vicente-Escrig
E
E
Mollá-Cantavella
S
S
Alós-Almiñana
M
M
D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016903:Drug Monitoring
D044966:Anti-Retroviral Agents