title: Comparison between guideline-preferred and nonpreferred first-line HIV antiretroviral therapy.
abstract: OBJECTIVE
  To compare antiretroviral therapy (ART) adherence and persistence and total healthcare expenditures in Medicaid-insured patients with human immunodeficiency virus (HIV) initiating preferred or nonpreferred first-line ART based on March 2012 HHS HIV treatment guidelines.
  
  
  METHODS
  Retrospective observational study using Medicaid administrative healthcare claims from 15 states.
  
  
  METHODS
  Subjects were HIV patients 18 to 64 years who initiated first-line HIV-related ART between January 1, 2007, and September 30, 2011, with continuous enrollment for 6 months prior to and at least 3 months following ART initiation. Patients were classified as having initiated preferred or nonpreferred ART based on March 2012 HHS HIV treatment guidelines. Outcomes were: ART adherence (proportion of days covered dichotomized at ≥80% and ≥95%), time to ART nonpersistence, and per patient per month (PPPM) total healthcare expenditures. Outcomes were evaluated using multivariable regressions.
  
  
  RESULTS
  Sample included 1979 patients initiating preferred ART regimens and 1614 patients initiating nonpreferred ART; overall mean age was 41 years; 48% of subjects were female. In the multivariable analyses, patients initiating preferred ART regimens had significantly greater odds of adherence ≥80% (odds ratio [OR], 1.38; 95% CI, 1.07-1.77) and adherence ≥95% (OR, 1.26; 95% CI, 1.05-1.51), and a significantly lower hazard of nonpersistence (HR, 0.48; 95% CI, 0.44-0.52). PPPM total healthcare expenditures were numerically lower for patients initiating preferred ART regimens (-$341; 95% CI, -$888 to $255) but the difference was not deemed significant.
  
  
  CONCLUSIONS
  This study reinforces the value of HHS recommendations for first-line ART. The potential impact of these findings will grow as more HIV patients become Medicaid-eligible under the Patient Protection and Affordable Care Act.
authors.affiliation: Truven Health Analytics, 7700 Old Georgetown Rd, Suite 650, Bethesda, MD 20814. Email: 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: Amanda M
authors.initials: AM
authors.lastname: Farr
authors.forename: Bong-Chul
authors.initials: BC
authors.lastname: Chu
authors.forename: Tony
authors.initials: T
authors.lastname: Hebden
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000592:standards* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents