title: Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.
abstract: BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART, -regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios.
  
  
  METHODS
  Antiretroviral regimens (ART) from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC)-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes.
  
  
  RESULTS
  During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70). Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively). Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%.
  
  
  CONCLUSIONS
  Analysis of the data of this nationwide study reflects disease-specific health services research and will give insights into the cost impacts of antiretroviral therapy, and might allow a more rational allocation of resources within the German health care system.
authors.affiliation: Infectious Diseases Unit, Medical University, Hanover, Germany. Stoll.Matthias@mh-hannover.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Stoll
authors.forename: Christian
authors.initials: C
authors.lastname: Kollan
authors.forename: Frank
authors.initials: F
authors.lastname: Bergmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Bogner
authors.forename: Gerd
authors.initials: G
authors.lastname: Faetkenheuer
authors.forename: Carlos
authors.initials: C
authors.lastname: Fritzsche
authors.forename: Kirsten
authors.initials: K
authors.lastname: Hoeper
authors.forename: Heinz-August
authors.initials: HA
authors.lastname: Horst
authors.forename: Jan
authors.initials: J
authors.lastname: van Lunzen
authors.forename: Andreas
authors.initials: A
authors.lastname: Plettenberg
authors.forename: Stefan
authors.initials: S
authors.lastname: Reuter
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rockstroh
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Stellbrink
authors.forename: Osamah
authors.initials: O
authors.lastname: Hamouda
authors.forename: Barbara
authors.initials: B
authors.lastname: Bartmeyer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D017046:Cost Savings / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination / Q000191:economics; D016568:Drugs, Generic / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D015658:HIV Infections / Q000188:drug therapy*; D054303:HIV Reverse Transcriptase / Q000037:antagonists & inhibitors; D006801:Humans; D008297:Male; D011480:Protease Inhibitors / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D016568:Drugs, Generic; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D054303:HIV Reverse Transcriptase