Background GESIDA 2018, the national guideline of AIDS in Spain, recommends, in the initial antiretroviral treatment (HAART) in adults infected with HIV, to use a simple target regime (STR) to favour adherence.
Purpose To analyse how naive HIV treatment has changed over the years both in economic aspects and in usual clinical practice.
Material and methods Longitudinal and descriptive observational study of the series of cases that began during the period January 2013 – September 2018 with antiretrovirals, naive patients only.The data have been extracted from the electronic medical record through the DRAGOAE and Farmatools program, are collected in an Excel spreadsheet and descriptive statistics are then made.The main variables under study were: initial antiretroviral treatment, patient cost per year and date of treatment initiation.
Results During this study period, 841 naive patients started treatment.
The patients who started per year from 2013 to 2017 were: 105, 180, 140, 146 and 170, respectively. The total annual cost of HAART was: €767,966.83, €1,339,510.52, €1,017,660.24, €1,051,474.85 and €1,122,105,72, respectively.
From January to September 2018, 100 patients started antiretroviral treatment and the total cost has been €584,434.94.The average cost per patient and year from 2013 to 2018 was: €7,313.96, €7,441.72, €7,269, €7,201.88, €6,600.62 and €5,844.35, respectively.
The treatments most frequently prescribed in the years 2013 to 2018 were:
2013: emtricitabine/tenofovir–disoproxil/rilpivirine (FTC/TDF/RPV) (31%), emtricitabine/tenofovir–disoproxil/efavirenz (FTC/TDF/EFV) (24%) and darunavir/ritonavir (DRV/r) + FTC/TDF (23%).
2014: FTC/TDF/RPV (30%), DRV/r+FTC/TDF (25%) and FTC/TDF/EFV (11%).
2015: abacavir/lamivudine/dolutegravir (ABC/3TC/DLG) (23%), FTC/TDF/RPV (16%), emtricitabine/tenofovir–disoproxil/elvitegravir/cobicistat (FTC/TDF/EVG/COBI) (13%) and FTC/TDF+DLG (13%).
2016: ABC/3TC/DLG (30%), FTC/TDF/EVG/COBI (19%) and FTC/TDF+DLG (16%).
2017: ABC/3TC/DLG (29%), emtricitabine/tenofovir–alafenamide/elvitegravir/cobicistat (FTC/TAF/EVG/COBI) (27%) and FTC/TDF+DLG (19%).
2018: ABC/3TC/DLG (28%), FTC/TDF+DLG (26%) and FTC/TAF/EVG/COBI (20%).
Conclusion The integrase inhibitors (DLG and EVG) have become the third drug of choice in the HAART of the naive patients. Moving to IPs and NNRTIs,the combination ABC/DLG/3TC is the most prescribed since 2015, and it is the most cost-effective STR in Spain. The average cost per patient has decreased by €1500/year on average compared to 2014. This is due to the high use of ABC/DLG/3TC and the current low cost of the combination FTC/TDF.
References and/or acknowledgements To my service.
No conflict of interest.
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