Background and Importance To analyse the potential budgetary impact of the introduction of cabotegravir (CAB) plus rilpivirine (RPV) long-acting in a third-level hospital.

Aim and Objectives To analyse the possible budgetary impact on our cohort of human immunodeficiency virus (HIV) patients.

Material and Methods Inclusion criteria: All active HIV-positive (HIV+) patients ≥18 years old ( with adherence ≥95% and undetectable viral load (<50 copies/mL) in the last 6 months) and with prescription and dispensing of combination oral antiretroviral therapy (ARTs) in our hospital. Study period: January to December 2022. Exclusion criteria: history of previous failure to non-nucleoside analogues or intolerance; HIV subtype A1-A6; body mass index (BMI) ≥30.

Variables collected Number of patients who meet the inclusion criteria, cost of active ARTs in 2022 and CAB 600 mg IM+RPV 900 mg IM long-acting (and CAB and RPV (oral lead-in)). Only direct pharmacological costs have been taken into account.

A Scenario 1 (CAB+RPV long-acting is not used) vs Scenario 2 (with the introduction of CAB+RPV long-acting throughout the year 2023).

Results Of the total of 2,065 HIV+ active patients in our hospital 1,882 patients have been included. 91% of the most prescribed ARTs: BIC/TAF/FTC in 32.74% (n=676); DTG/3TC in 32.15% (n=664); TAF/FTC/RVP in 8.09% (n=167); DRV/c/FTC in 7.94% (n=164); DTG/ABC/3TC in 5.33% (n=110) and DTG/RVP in 4.89% (n=101). 14% (n=268/1,882) already have RPV in their oral ARTs and would not have to do oral lead-in with CABO+RPV the previous month. Only 90% (n=1,694) met all the inclusion criteria. It has been estimated that only 10% of patients would change oral ARTs for long-acting therapy (n=169).

The cost of scenario 1 for the 169 patients would be €1,808,525.11/year. In scenario 2, 87% of the patients (n=147/169) would switch to long-acting ART after oral lead-in with CAB+RPV the previous month at a cost of €1,659,737.31/year; and 13% (N=22/169) would go directly to ART long-acting with a cost of €265,228.04/year. The overall value of scenario 2 would be €1,924,965.35/year. The difference in costs would be +€116,440.24/year.

Conclusion and Relevance Without taking into account other types of costs, the introduction of CAB+RPV long-acting in a third-level hospital would imply a higher cost vs using oral ARTs.

Conflict of Interest No conflict of interest.