Budget impact of antiretroviral therapy in a French clinic cohort.
In this study, we first assessed costs associated with the use of antiretroviral therapy (ART) in an infectious diseases University Hospital Clinic; second, we evaluated characteristics associated with these costs and finally simulated the impact on the overall ART budget of switching first-line and second-line regimens to less-costly regimens (as effective and well tolerated).



Cohort analysis including persons living with HIV (PLHIV) aged at least 18 years on ART to estimate ART costs during 2014.



The current study was conducted in the Bichat-Claude Bernard University Hospital Clinic in Paris, France, where 4501 PLHIV consulted in 2014. We used the medical database Nadis to describe patients' ART, characteristics and estimated costs. When assessing the budgetary impact of potential switches, we considered patients' history of failure, CD4 cell count, plasma viral load, resistance mutations, hepatitis B surface antigen or HLAB5701 profile.



A total of 4238 of 4501 patients were on ART (94%). The total annual cost of ART prescribed was estimated at &OV0556;48 280 200 in 2014; first/second (simplification)-line regimens represented 25% (1076/4238) of the treated PLHIV and 23% (&OV0556;11 209 000) of the annual cost. For these PLHIV, we considered switches from the most common ART regimens (protease inhibitor boosted by ritonavir or nonnucleoside reverse transcriptase inhibitor + two nucleoside reverse transcriptase inhibitors) to less-expensive regimens. We found savings ranging from &OV0556;36 100 to 1472 600/year. Savings were the highest when we considered switching to generic-based regimens or from protease inhibitor-based triple therapy to protease inhibitor monotherapy.



Costs associated with ART prescriptions are very high. Switches to generic-based regimens are associated with large savings. However, those targeting protease inhibitor regimens are also associated with substantial savings and should be considered.
aIAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité bInfectious Diseases Clinic, Bichat-Claude Bernard University Hospital, AP-HP cCOREVIH Ile De France Nord, Paris dVirology Department, Bichat-Claude Bernard University Hospital, AP-HP ePharmaco-Toxicology Department, Bichat-Claude Bernard University Hospital, AP-HP fPharmacy/Patient Education Program on ART, Bichat-Claude Bernard University Hospital, AP-HP, Paris gAIDES, Paris hInstitute of Psychology - Lumière Lyon 2 University, GRePS - EA 4163, Bron iInternal Medicine, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre jINSERM U1018 - CESP, University Paris Sud, Le Kremlin-Bicêtre, France.
Emmanuelle
E
Papot
Roland
R
Landman
Françoise
F
Louni
Charlotte
C
Charpentier
Gilles
G
Peytavin
Agnès
A
Certain
Clémence
C
Fradet
Daniela R
DR
Castro
Marie
M
Preau
Cécile
C
Goujard
Patrick
P
Yeni
Yazdan
Y
Yazdanpanah
D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics* / Q000379:methods*; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D055815:Young Adult
D044966:Anti-Retroviral Agents