title: Cost analysis of HIV treatment and drug-related adverse events when fixed-dose combinations of antiretrovirals (FDCs) were stopped, versus continuation with FDCs.
abstract: BACKGROUND
  The lower sales price of generic lamivudine has caused healthcare administrators to consider abolishing fixed-dose antiretroviral combinations (FDCs) that contain lamivudine and emtricitabine. The alternative is to administer the individual components of the FDCs separately, thus incorporating the new generic lamivudine medication.
  
  
  METHODS
  The Balearic Islands Health Service ordered the discontinuation of the treatment with FDCs in July 2010, but FDCs were reintroduced in August 2010. At that point, an independent, retrospective cost analysis was performed by Son Llàtzer Hospital. A total of 75 patients who were treated from July to August 2010 underwent replacement of their FDC treatment with the individual components. Additionally, 150 patients who continued using FDCs were randomly selected. For both patient groups, the antiretroviral therapy that was administered and the costs associated with management of adverse events were recorded. The study period used for the cost calculations was the average number of days that patients used separate components of FDCs (120 days). An alternative analysis was performed to consider the costs of the extra follow-up visit (consultation and clinical tests) that was required for patients who changed their antiretroviral therapy.
  
  
  RESULTS
  Considering antiretroviral therapies and adverse events, the administration of the separate components increased the total daily cost by 0.72 € per patient compared to treatment with FDCs. When the cost of an extra follow-up visit was considered, the daily cost increased by 3.61 € per patient.
  
  
  CONCLUSIONS
  Our study suggests that the discontinuation of FDC treatment and the replacement with the administration of separate antiretroviral agents could lead to an increase in healthcare costs due to the higher rate of adverse events that was observed with the discontinuation of FDCs.
authors.affiliation: Pharmacoeconomics and Outcomes Research Iberia (PORIB), Calle de la Golondrina, 40A, Madrid, 28023, Spain. vlozano@porib.com.
authors.forename: Francesc
authors.initials: F
authors.lastname: Homar
authors.forename: Virginia
authors.initials: V
authors.lastname: Lozano
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez-Gómez
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
authors.forename: Antonio
authors.initials: A
authors.lastname: Pareja
authors.forename: Antoni
authors.initials: A
authors.lastname: Payeras
authors.forename: Joaquín
authors.initials: J
authors.lastname: Serrano
authors.forename: Carmen
authors.initials: C
authors.lastname: Carratalá
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Casado