Background Antiretroviral treatment administered within 48–72 h after exposure might reduce the risk of acquiring HIV infection. Due to the urgency of an initiating treatment, some of these PEP treatments are prescribed in the emergency department (ED) by a non-HIV specialist. Therefore, PEP starter packs were created to ensure the correct treatment until the visit to an HIV specialist.
Purpose To describe the use of PEP treatment starter packs in ED. We also calculated the cost savings resulting from dispensing daily packs until the HIV specialist visit.
Materials and methods The PEP treatment was agreed between the HIV team and pharmacy department according to European ART clinical practice guidelines. Daily PEP kits containing lopinavir/ritonavir, emtricitabine and tenofovir are prepared in the pharmacy department and are available in ED with enclosed information for the patient. If a patient arrives at the ED with suspected exposure, PEP kits are dispensed until the visit to the HIV specialist. Data were collected since the introduction of PEP packs in December 2011 from hospital electronic records. Treatment cost was calculated from manufacturer sales price plus 4% VAT.
Results 36 PEP were initiated. 64% male, with a mean age of 33.7 (17–52). After visiting the HIV specialist, 27 (75%) patients remained on the same treatment while 9 (25%) were changed: 4 (11%) patients from lopinavir to darunavir, 3 (8%) to atazanavir and 2 (6%) to raltegravir. 7 (20%) patients changed due to gastrointestinal side effects, 1 (2.5%) for drug interactions and 1 (2.5%) for unknown reasons. Treatment with lopinavir/ritonavir, emtricitabine and tenofovir cost 800.6 €/month; therefore PEP kits have saved the hospital 7,205.49 € from those patients who changed treatment.
Conclusions PEP kits have guaranteed that the correct treatment is supplied in the ED. Treatment is well tolerated, nevertheless in some patients must be changed. Accordingly, dispensing daily packs instead of full drug containers seems to be a cost-effective strategy.
No conflict of interest.
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