title: Economic impact of optimising antiretroviral treatment in human immunodeficiency virus-infected adults with suppressed viral load in Spain, by implementing the grade A-1 evidence recommendations of the 2015 GESIDA/National AIDS Plan.
abstract: The objective of this study is to estimate the economic impact associated with the optimisation of triple antiretroviral treatment (ART) in patients with undetectable viral load according to the recommendations from the GeSIDA/PNS (2015) Consensus and their applicability in the Spanish clinical practice.
  
  
  
  A pharmacoeconomic model was developed based on data from a National Hospital Prescription Survey on ART (2014) and the A-I evidence recommendations for the optimisation of ART from the GeSIDA/PNS (2015) consensus. The optimisation model took into account the willingness to optimise a particular regimen and other assumptions, and the results were validated by an expert panel in HIV infection (Infectious Disease Specialists and Hospital Pharmacists). The analysis was conducted from the NHS perspective, considering the annual wholesale price and accounting for deductions stated in the RD-Law 8/2010 and the VAT.
  
  
  
  The expert panel selected six optimisation strategies, and estimated that 10,863 (13.4%) of the 80,859 patients in Spain currently on triple ART, would be candidates to optimise their ART, leading to savings of €15.9M/year (2.4% of total triple ART drug cost). The most feasible strategies (>40% of patients candidates for optimisation, n=4,556) would be optimisations to ATV/r+3TC therapy. These would produce savings between €653 and €4,797 per patient per year depending on baseline triple ART.
  
  
  
  Implementation of the main optimisation strategies recommended in the GeSIDA/PNS (2015) Consensus into Spanish clinical practice would lead to considerable savings, especially those based in dual therapy with ATV/r+3TC, thus contributing to the control of pharmaceutical expenditure and NHS sustainability.
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, España. Electronic address: eriberap@gmail.com.
authors.forename: Esteban
authors.initials: E
authors.lastname: Ribera
authors.affiliation: Servicio de Farmacia, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Martínez-Sesmero
authors.affiliation: Servicio de Farmacia, Hospital Universitario de Getafe, Getafe, Madrid, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Sánchez-Rubio
authors.affiliation: Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rubio
authors.affiliation: Sección de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: Juan
authors.initials: J
authors.lastname: Pasquau
authors.affiliation: Servicio de Farmacia, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Poveda
authors.affiliation: Oblikue Consulting S.L., Barcelona, España.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pérez-Mitru
authors.affiliation: Departamento Médico, Bristol-Myers Squibb, Madrid, España.
authors.forename: Celia
authors.initials: C
authors.lastname: Roldán
authors.affiliation: Departamento Médico, Bristol-Myers Squibb, Madrid, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Hernández-Novoa
mesh_terms: D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D019983:Guideline Adherence / Q000191:economics*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D017410:Practice Guidelines as Topic; D013030:Spain; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: Antiretroviral Therapy; Budget impact; Cost; Coste; Gasto sanitario; Health Expenditures; Human immunodeficiency virus; Impacto presupuestario; Optimisation; Optimización; Tratamiento antirretroviral; Virus de la inmunodeficiencia humana