title: Comparative incidence and health care costs of medically attended adverse effects among U.S. Medicaid HIV patients on atazanavir- or darunavir-based antiretroviral therapy.
abstract: OBJECTIVE
  This is the first study to compare the incidence and health care costs of medically attended adverse effects in atazanavir- and darunavir-based antiretroviral therapy (ART) among U.S. Medicaid patients receiving routine HIV care.
  
  
  METHODS
  This was a retrospective study using Medicaid administrative health care claims from 15 states. Subjects were HIV patients aged 18 to 64 years initiating atazanavir- or darunavir-based ART from January 1, 2003, to July 1, 2010, with continuous enrollment for 6 months before (baseline) and 6 months after (evaluation period) ART initiation and 1 or more evaluation period medical claim. Outcomes were incidence and health care costs of the following medically attended (International Classification of Diseases, Ninth Revision, Clinical Modification-coded or treated) adverse effects during the evaluation period: gastrointestinal, lipid abnormalities, diabetes/hyperglycemia, rash, and jaundice. All-cause health care costs were also determined. Patients treated with atazanavir and darunavir were propensity score matched (ratio = 3:1) by using demographic and clinical covariates. Multivariable models adjusted for covariates lacking postmatch statistical balance.
  
  
  RESULTS
  Propensity-matched study sample included 1848 atazanavir- and 616 darunavir-treated patients (mean age 41 years, 50% women, 69% black). Multivariable-adjusted hazard ratios (HRs) (for darunavir, reference = atazanavir) and per-patient-per-month health care cost differences (darunavir minus atazanavir) were as follows: gastrointestinal, HR = 1.25 (P = 0.04), $43 (P = 0.13); lipid abnormalities, HR = 1.38 (P = 0.07), $3 (P = 0.88); diabetes/hyperglycemia, HR = 0.84 (P = 0.55), $13 (P = 0.69); and rash, HR = 1.11 (P = 0.23), $0 (P = 0.76); all-cause health care costs were $1086 (P<0.001). Too few instances of jaundice (11 in atazanavir and 1 in darunavir) occurred to support multivariable modeling.
  
  
  CONCLUSIONS
  Medication tolerability can be critical to the success or failure of ART. Compared with darunavir-treated patients, atazanavir-treated patients had significantly fewer instances of medically attended gastrointestinal issues and more instances of jaundice and incurred significantly lower health care costs.
authors.affiliation: Truven Health Analytics, Washington, DC, USA. stephen.johnston@truvenhealth.com
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Johnston
authors.forename: Timothy
authors.initials: T
authors.lastname: Juday
authors.forename: Stephen
authors.initials: S
authors.lastname: Esker
authors.forename: Derek
authors.initials: D
authors.lastname: Espindle
authors.forename: Bong-Chul
authors.initials: BC
authors.lastname: Chu
authors.forename: Tony
authors.initials: T
authors.lastname: Hebden
authors.forename: Jonathan
authors.initials: J
authors.lastname: Uy
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000069446:Atazanavir Sulfate; D000069454:Darunavir; D005076:Exanthema / Q000139:chemically induced / Q000191:economics; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000191:economics; D044882:Glucose Metabolism Disorders / Q000139:chemically induced / Q000191:economics; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D007565:Jaundice / Q000139:chemically induced / Q000191:economics; D052439:Lipid Metabolism Disorders / Q000139:chemically induced / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects* / Q000191:economics* / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects* / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D013449:Sulfonamides / Q000009:adverse effects* / Q000191:economics* / Q000627:therapeutic use; D014481:United States; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D013449:Sulfonamides; D000069446:Atazanavir Sulfate; D000069454:Darunavir