Hidden costs of antiretroviral treatment: the public health efficiency of drug packaging.
While the overall percentage of unused antiretroviral medicines returned to the hospital pharmacy is low, their cost is quite high. Adverse events, treatment failure, pharmacokinetic interactions, pregnancy, or treatment simplification are common reasons for unplanned treatment changes. Socially inefficient antiretroviral packages prevent the reuse of drugs returned to the hospital pharmacy. We defined antiretroviral package categories based on the excellence of drug packaging and analyzed the number of pills and costs of drugs returned during a period of 1 year in a hospital-based HIV unit attending to 2,413 treated individuals. A total of 6,090 pills (34% of all returned antiretrovirals) - with a cost of 47,139.91 € - would be totally lost, mainly due to being packed up in the lowest efficiency packages. Newer treatments are packaged in low-excellence categories of packages, thus favoring the maintenance of these hidden costs in the near future. Therefore, costs of this low-efficiency drug packaging, where medication packages are started but not completed, in high-cost medications are substantial and should be properly addressed. Any improvement in the packaging by the manufacturer, and favoring the choice of drugs supplied through efficient packages (when efficacy, toxicity, and convenience are similar), should minimize the treatment expenditures paid by national health budgets.
Pharmacy Department, University Hospital Germans Trias i Pujol, Badalona, Spain.
Àngels
À
Andreu-Crespo
HIV Unit and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain ; Universitat Autònoma de Barcelona, Vic, Barcelona, Spain.
Josep M
JM
Llibre
Pharmacy Department, University Hospital Germans Trias i Pujol, Badalona, Spain.
Glòria
G
Cardona-Peitx
Pharmacy Department, University Hospital Germans Trias i Pujol, Badalona, Spain.
Ferran
F
Sala-Piñol
HIV Unit and "Lluita contra la SIDA" Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain ; Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Barcelona, Spain.
Bonaventura
B
Clotet
Pharmacy Department, University Hospital Germans Trias i Pujol, Badalona, Spain.
Xavier
X
Bonafont-Pujol
D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004347:Drug Interactions; D004349:Drug Packaging / Q000191:economics*; D057915:Drug Substitution; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008297:Male; D010607:Pharmacy Service, Hospital / Q000191:economics; D011247:Pregnancy; D011634:Public Health / Q000191:economics*; D013997:Time Factors; D017211:Treatment Failure
D044966:Anti-Retroviral Agents
antiretroviral treatment; cost efficacy; drug packaging; treatment change