title: Persistence, adherence, and all-cause healthcare costs in atazanavir- and darunavir-treated patients with human immunodeficiency virus in a real-world setting.
abstract: OBJECTIVE
  Atazanavir (ATV) and darunavir (DRV) are protease inhibitors approved for HIV treatment in combination with ritonavir (/r). The objectives of this study were to compare persistence (time to treatment discontinuation/modification), adherence, and healthcare costs among patients with human immunodeficiency virus (HIV) initiating ATV/r or DRV/r.
  
  
  METHODS
  This retrospective cohort study used commercial and Medicaid administrative insurance claims data. Patients initiating ATV/r or DRV/r from 2006-2013 with continuous enrollment for ≥6 months before and ≥3 months after initiation were included. Patients were followed from initiation until discontinuation/modification (≥30 day gap in ATV or DRV or initiation of a new antiretroviral medication), during which time adherence (proportion of days covered [PDC], with PDC ≥80% or 95% considered adherent) and per-patient per-month (PPPM) total healthcare costs were measured. DRV/r patients were propensity score matched to ATV/r patients at a 1:1 ratio to achieve balance on potentially confounding demographic and clinical factors. Commercial and Medicaid samples were analyzed separately, as were antiretroviral (ART)-naïve and experienced patients.
  
  
  RESULTS
  The final samples comprised 2988 commercially-insured and 1158 Medicaid-insured patients. There were no significant differences in hazards of discontinuation/modification between the ATV/r or DRV/r cohorts. With respect to odds of being adherent, the only marginally significant result was comparing odds of achieving PDC ≥80% among ART-naïve Medicaid patients, which favored ATV/r. All other adherence comparisons were not significant. Although ATV/r cohorts tended to have lower PPPM costs, the majority of these differences were not statistically significant.
  
  
  CONCLUSIONS
  Patients with HIV treated with either ATV/r or DRV/r had similar time to treatment discontinuation/modification, adherence, and monthly healthcare costs. Results were similar across the pre-specified sub-groups. These findings are useful not only as an insight into clinical practice, but also as a resource for healthcare providers and payers evaluating treatment options for HIV+ individuals.
authors.affiliation: a a Truven Health Analytics, Life Sciences , Cambridge , MA , USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Farr
authors.affiliation: b b Truven Health Analytics, Life Sciences , Bethesda , MD , USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Johnston
authors.affiliation: c c Bristol-Myers Squibb, US Medical HIV , Princeton , NJ , USA.
authors.forename: Corey
authors.initials: C
authors.lastname: Ritchings
authors.affiliation: a a Truven Health Analytics, Life Sciences , Cambridge , MA , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Brouillette
authors.affiliation: d d Bristol-Myers Squibb, US Medical , Plainsboro , NJ , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rosenblatt
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000069446:Atazanavir Sulfate / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D000069454:Darunavir / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D017059:Models, Econometric; D057216:Propensity Score; D012189:Retrospective Studies; D019438:Ritonavir / Q000627:therapeutic use; D012959:Socioeconomic Factors; D014481:United States; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D000069446:Atazanavir Sulfate; D019438:Ritonavir; D000069454:Darunavir
keywords: Adherence; Healthcare costs; Human immunodeficiency virus; Persistence; Protease inhibitors