Simplified HIV Treatments Can Lead to Lower Healthcare Costs

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Complexity surrounding HIV treatments leads to an overall decline in adherence, according to the results of a study published in the Journal of Managed Care and Specialty Pharmacy last week. This leads researchers to conclude that switching from a multi-pill treatment to a single pill will improve patient outcomes.

To come to this conclusion, a team of researchers led by Amy Colson, M.D., MPH a research director at AccessHealth MA, a health councilor in Boston, used the Optum Research Database to calculate the rate at which 4,251 HIV patients started, stopped or switched antiretrovirals between January 1, 2018, and December 31, 2019.

The antiretroviral regimens measured included:

bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) (single tablet)

• dolutegravir/abacavir/lamivudine (/ABC/3TC/DTG) (single tablet)

• olutegravir + emtricitabine/tenofovir disoproxil fumarate (FTC/TDF+DTG) (multi-tablet)

dolutegravir + emtricitabine/tenofovir alafenamide (FTC/TAF+DTG) (multi-tablet)

Monthly HIV-related medical costs for each were:

$699 for B/F/TAF

$770 for DTG/ABC/3TC

$3,570 for DTG+FTC/TDF

$817 for DTG+FTC/TAF

“It remains unclear what the reasons are for these differences,” Colson and her team write. “Because one of the drivers of differences in health care cost was pharmacy costs, it is possible that filling multiple medications contributes to higher costs than filling a single tablet regimen.”

HIV is an extremely expensive disease to treat. As of 2021, there are an estimated 1.2 million people in the United States living with HIV. A study from the same year estimated that the average person with HIV can expect to spend a lifetime average of $326,411 to $490,045, or about $31,147 annually, which is eight to nine times higher than costs associated with cardiovascular disease or diabetes. Factors that contribute to this cost are inpatient and outpatient services, opportunistic infection prevention, non-HIV medications, emergency care, associated testing and treatment. The costliness of HIV treatment can reduce treatment adherence, which can lead to higher mortality rates and further spread of HIV.

For HIV patients new to HIV treatment, the US Department of Health and Human Services (DHHS) first recommends a triple drug regimen to get the virus under control. Patients can then later switch to single drug treatment once viral suppression is achieved. Once treatment is started, it usually takes about three to six months for the virus to become undetectable.

“After weighting and additional covariate adjustment for relevant baseline demographic and clinical characteristic differences, HIV-related medical costs were the lowest for treatment-experienced people with HIV receiving B/F/TAF,” Colson and her team continue. “Selecting the appropriate treatment regimen may help treatment-experienced people with HIV maintain lower HIV-related medical costs.”