Costes y adherencia del tratamiento antirretroviral |
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| Authors: | J.M. Ventura-Cerdá D. Ayago-Flores E. Vicente-Escrig S. Mollá-Cantavella M. Alós-Almiñana |
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| Affiliation: | 1. Department of General Surgery, Third Xiangya Hospital, Central South University, People’s Republic of China;2. Department of Surgery, Englewood Hospital and Medical Center, New Jersey;1. University of Brasília, Brasilia, Brazil;2. Gastrocirurgia Clinic, private practice, Brasilia, Brazil;1. National Health Risk Management, EPS Salud Total, Bogotá D.C. Colombia;2. Faculty of Science, Pharmacy Department, National University of Colombia, Bogotá D.C., Colombia;1. Infectious Diseases Department and “Lluita contra la SIDA” Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain;2. Universitat Autònoma de Barcelona, Spain;3. Fundació Clinic per a la Recerca Biomèdica, Hospital Clinic/IDIBAPS, Barcelona, Spain;4. Infectious Diseases, St. Louis Hospital, Paris Diderot University, Paris, France;5. Infectious Diseases, Hospital La Paz, Madrid, Spain;6. HIV Unit, Infectious Disease Service, IDIBELL-Hospital Universitari de Bellvitge, L’Hospitalet, Barcelona, Spain;7. UAB, UVIC-UCC, IEC, Spain;8. Hospital de Sant Pau, Barcelona, Spain;9. Infectious Diseases & AIDS Units, Hospital Clinic/IDIBAPS, University of Barcelona, Barcelona, Spain;1. Instituto de Telecomunicações, Avenida Rovisco Pais, P-1049-001 Lisboa, Portugal;2. Department of Chemistry and QOPNA, University of Aveiro, P-3810-193 Aveiro, Portugal;3. Department of Bioengineering, Instituto Superior Técnico, Technical University of Lisbon, Avenida Rovisco Pais, P-1049-001 Lisboa, Portugal |
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| Abstract: | ObjectiveTo develop a system of data management that allows us to estimate the comparative effectiveness of the various antiretroviral treatment (ART) regimens.MethodRestrospective observational study in patients infected with HIV with stable ART. Adherence to treatment and unit cost for each patient's treatment was determined. The cost/patient/day was calculated and, multiplying by an adherence factor (fADH), the (cost/patient/day)ADH. The comparison of both allowed us to obtain the Δcost/patient, which estimates the additional costs caused by lack of adherence. The incremental cost-effectiveness (iCER), grouping the results by the various coformulated drugs (“combos”). A study of the budgetary impact of these combos was carried out.Results468 patients were evaluated (62% adherent). Average adherence was 88±18%. The average value of (cost/patient/day) ADH was significantly higher than the cost/patient/day (27.3 ± 9.8€ compared to 24.3±7.6€. p < 0.001). Just as with the fADH, no differences were found in the Δcost/patient between the different ART combinations. The combo with the least deviation from the cost/patient/day due to lack of adherence was that composed of abacavir/zedovudine/lamivudine (ABC/AZT/3TC,Δcost/patient=8.72±14.18%), and that with the greatest deviation AZT/3TC (Δcost/patient=13.52±17.68%). No significant differences were found in the iCER calcluated for any combo. The ART that included abacavir/lamivudine (ABC/3TC) obtained the least budgetary impact.ConclusionsThe greatest cost and percentage of adherent patients associated with the combos composed of Tenovovir/Emtricitabine(TDF/FTC) and ABC/3TC, and the least cost and effectiveness of those composed of AZT/#TC and ABC/AZT/3TC, does not allow us to identify any option as significantly dominant. The regimens with ABC/3TC were shown to be the most favourable from the combined point of view of cost and adherence. |
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