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Drug supply/logistics (including: computeraided drug dispatching and ward pharmacies)
Simplification of ARV treatment with lopinavir/ritonavir: clinical assessment and financial impact
  1. A. Valle Díaz de la Guardia,
  2. C. Medarde Caballero,
  3. C. Fernández López,
  4. J. Cabeza Barrera
  1. 1Hospital Universitario San Cecilio, Farmacia Hospitalaria, Granada, Spain

Abstract

Background Simplification of antiretroviral treatment (ART) is a very useful therapeutic tool to facilitate adherence and prevent or reverse some adverse effects.

Purpose To monitor patients with simplified ART to assess clinical response, adherence and the financial savings of the simplification.

Materials and methods The authors selected patients who were given simplified ART in 2010 with the combination lopinavir/ritonavir. For each patient the ART before simplification, the CD4 cell count and viral load were analysed. The authors also noted the reason for the initiation of simplified ART and dispensing records from the Pharmacy department were used to calculate the adherence. The cost savings were calculated by comparing the cost of the patient's last ART and the cost of the simplified ART, using the official laboratory price and the number of prescriptions dispensed.

Results 20 patients were included in the study. 90% of them had been taking at least two antiretroviral regimens before starting the simplified treatment. All patients completed at least 6 months with an undetectable viral load (<50 copies/mL) before starting simplified ART. In 100% of the cases, the reason for simplification was greater immunological and virological control of the patient. The viral load at 3 months of treatment remained undetectable in all patients. There were no adverse effects or dropouts, the adherence was above 90% in all cases and all patients had a good immune status. Regarding the financial impact of ART change, the difference between the old ART and the new simplified regimen was found for each patient. The overall cost of the simplified ART was 83,506€. If patients had continued with the previous ART, the cost would have been 159,189€. Therefore, the cost saving resulting was 75,683€.

Conclusions Simplified ART with lopinavir/ritonavir is a regimen with significant cost savings and no loss of virological efficacy or adverse effects.

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