title: Does combining antiretroviral agents in a single dosage form enhance quality of life of HIV/AIDS patients? A cost-utility study.
abstract: BACKGROUND
  Combining various antiretroviral agents into one single dosage form has been a strategy to reduce pill burden and enhance medication adherence among human immunodeficiency virus /AIDS (HIV/AIDS) patients.
  
  
  OBJECTIVE
  This is a cost-utility study from a health care system's perspective comparing coformulated fixed dose (FXD) strategy versus multiple free dose combination (FRC) in antiretroviral therapy.
  
  
  METHODS
  The Medical Expenditure Panel Survey (MEPS) was used to identify HIV/AIDS patients with ≥2 active antiretroviral medications. Patients on FXD were matched in 1:1 ratio with the FRC group using propensity scores. All medical costs excluding those paid by patients and families were included. Utility was measured using SF-6D scores from the SF-12 questionnaire. Incremental cost-utility ratios (ICURs) were calculated using the mean annual estimates. A cost-effectiveness acceptability curve was determined using a Monte Carlo probabilistic simulation technique.
  
  
  RESULTS
  Nine FXD antiretroviral formulations approved by the U.S. Food and Drug Administration by 2005 was included in this study. One hundred seventy HIV/AIDS patients with ≥2 antiretroviral agents were identified from the MEPS database, of which 53% (n=92) were on FXD formulation. On matching, 70 patients from FXD had a match from the FRC group. No differences in sociodemographic and health status variables were observed between the matched groups. The mean annual cost was $15,766.15 for FXD patients and $11,875.21 for FRC patients. The mean utility gained by using FXD over FRC was 0.085; however, this difference was not statistically significant. The ICUR for the FXD treatment over FRC treatment was $45,540.49/quality-adjusted life years (QALYs). Probabilistic sensitivity analysis showed FXD to dominate FRC (>50% probability of being cost-effective) above the $40,000 threshold.
  
  
  CONCLUSIONS
  Although the cost-effectiveness of a single-pill strategy was within the acceptable willingness-to-pay threshold, the QALY difference were minimal. Further research is recommended to explore the long-term impact of the strategy.
authors.affiliation: Health Outcomes and Policy Research, Department of Pharmaceutical Sciences, University of Tennessee College of Pharmacy, 847 Monroe Ave., Memphis, TN 38163, USA. arijit.gangs@gmail.com
authors.forename: Arijit
authors.initials: A
authors.lastname: Ganguli
authors.forename: Junling
authors.initials: J
authors.lastname: Wang
authors.forename: Dick R
authors.initials: DR
authors.lastname: Gourley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D016527:Drug Costs; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D004338:Drug Combinations