Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV

Calvin J Cohen, Juliana L Meyers, Keith L Davis, Calvin J Cohen, Juliana L Meyers, Keith L Davis

Abstract

Objectives: Lower pill burden leads to improved antiretroviral therapy (ART) adherence among HIV patients. Simpler dosing regimens have not been widely explored in real-world populations. We retrospectively assessed ART adherence, all-cause hospitalisation risk and costs, and other healthcare utilisation and costs in Medicaid enrollees with HIV treated with ART as a once-daily single-tablet regimen (STR) or two or more pills per day (2+PPD).

Design: Patients with an HIV diagnosis from 2005 to 2009 receiving complete ART (ie, two nucleoside/nucleotide reverse transcriptase inhibitors plus a third agent) for ≥60 days as STR or 2+PPD were selected and followed until the first of (1) discontinuation of the complete ART, (2) loss of enrolment or (3) end of database. Adherence was measured using the medication possession ratio. Monthly all-cause healthcare utilisation and costs were observed from regimen initiation until follow-up end.

Results: Of the 7381 patients who met inclusion criteria, 1797 were treated with STR and 5584 with 2+PPD. STR patients were significantly more likely to reach 95% adherence and had fewer hospitalisations than 2+PPD patients (both p<0.01). STR patients had mean (SD) total monthly costs of $2959 ($4962); 2+PPD patients had $3544 ($5811; p<0.001). Hospital costs accounted for 53.8% and pharmacy costs accounted for 32.5% of this difference. Multivariate analyses found that STR led to a 23% reduction in hospitalisations and a 17% reduction in overall healthcare costs. ART adherence appears to be a key mechanism mediating hospitalisation risk, as patients with ≥95% adherence (regardless of regimen type) had a lower hospitalisation rate compared with <95% adherence.

Conclusions: While it was expected that STR patients would have lower pharmacy costs, we also found that STR patients had fewer hospitalisations and lower hospital costs than 2+PPD patients, resulting in significantly lower total healthcare costs for STR patients.

Keywords: Health Economics; Therapeutics.

Figures

Figure 1
Figure 1
Sample selection flow chart.
Figure 2
Figure 2
Adjusted rate of hospitalisations per 100 patient-years, by cohort.
Figure 3
Figure 3
Hospitalisations per 100 patient-years, by cohort and adherence.
Figure 4
Figure 4
Adjusted monthly healthcare costs, by cohort.

References

    1. Thompson MA, Aberg JA, Cahn P, et al. Recommendations of the IAS-USA Panel. JAMA 2010;304:321–33
    1. Henry K. Report from the 17th Conference on Retroviruses and Opportunistic Infections. More data and answers from ACTG 5202. J Watch AIDS Clin Care 2010;22:30.
    1. Rockstroh JK, Lennox JL, Dejesus E, et al. STARTMRK Investigators Long-term treatment with raltegravir or efavirenz combined with tenofovir/emtricitabine for treatment-naïve human immunodeficiency virus-1-infected patients: 156-week results from STARTMRK. Clin Infect Dis 2011;53:807–16
    1. Fielden SJ, Rusch ML, Yip B, et al. Nonadherence increases the risk of hospitalization among HIV-infected antiretroviral naïve patients started on HAART. J Int Assoc Phys AIDS Care 2008;7:238–44
    1. Kitahata MM, Reed SD, Dillingham PW, et al. Pharmacy-based assessment of adherence to HAART predicts virological and immunologic treatment response and clinical progression to AIDS and death. Int J STD AIDS 2004;15:803–10
    1. Wood E, Hogg RS, Yip B, et al. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 × 109 cells/L. Ann Intern Med 2003;139:810–16
    1. Bangsberg DR, Perry S, Charlebois ED, et al. Nonadherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS 2001;15:1181–3
    1. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000;133:21–30
    1. Arnsten J, Demas P, Farzadegan H, et al. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis 2001;33:1417–23
    1. Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis 2006;43:939–41
    1. Panel on Antiretroviral Guidelines for Adults and Adolescents, Department of Health and Human Services. 2009. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescnets. (accessed 25 Aug 2012)
    1. DeJesus E, Young B, Morales-Ramirez JO, et al. Simplification of antiretroviral therapy to a single tablet regimen consisting of efavirenz, emtricitabine and tenofovir disoproxil fumarate versus unmodified antiretroviral therapy in virologically suppressed HIV-1-infected patients. J Acquir Immune Defic Syndr 2009;51:163–74
    1. Hodder SL, Mounzer K, DeJesus E, et al. Patient-reported outcomes in virologically suppressed, HIV-1-infected subjects after switching to a simplified, single tablet regimen of efavirenz, emtricitabine and tenofovir DF. AIDS Patient Care STDs 2010;24:115–25
    1. Airoldi M, Zaccarelli M, Bisi L, et al. One-pill once-a-day HAART: a simplification strategy that improves adherence and quality of life of HIV-infected subjects. Patient Prefer Adherence 2010;4:115–25
    1. Bangsberg DR, Ragland K, Monk A, et al. A single tablet regimen is associated with higher adherence and viral suppression than multiple tablet regimens in HIV+ homeless and marginally housed people. AIDS 24:2835–40
    1. Sax PE, Meyers JL, Mugavero M, et al. Adherence to antiretroviral treatment and correlation with risk of hospitalization among commercially insured HIV patients in the United States. PLoS ONE 7:e31591.
    1. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–83
    1. Andrade SE, Kristijan KH, Frech F, et al. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15:565–74
    1. Legorreta A, Yu A, Chernicoff H, et al. Adherence to combined lamivudine + zidovudine versus individual components: a community-based retrospective Medicaid claims analysis. AIDS Care 2005;17:938–48
    1. Juday T, Gupta S, Grimm K, et al. Factors associated with complete adherence to HIV combination antiretroviral therapy. HIV Clin Trials 12:71–8
    1. Cohen CJ, Davis KL, Meyers J. Association of partial adherence to antiretroviral therapy with hospitalizations and healthcare costs in an HIV population. Poster presented at the 11th International Congress on Drug Therapy in HIV Infection. Glasgow, UK, 2012
    1. Gebo KA, Diener-West M, Moore RD. Hospitalization rates in an urban cohort after the introduction of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2006;27:143–52
    1. Fleming PL, Byers RH, Sweeney PA, et al. HIV prevalence in the United States, 2000. Abstract presented at: 9th Conference on Retroviruses and Opportunistic Infections. Seattle, WA, 2002
    1. Samet JH, Freedberg KA, Savetsky JB, et al. Understanding delay to medical care for HIV infection: the long-term non-presenter. AIDS 2001;15:77–85
    1. Metsch LR, Bell C, Pereyra M, et al. Hospitalized HIV-infected patients in the era of highly active antiretroviral therapy. Am J Public Health 2009;99:1045–9
    1. Burman W, Clumeck N, Cohen CJ, et al. CD4+ count-guided interruption of antiretroviral treatment. N Eng J Med 2006;355:2283–96
    1. Cohen CJ, Colson AE, Pierone G, et al. The FOTO study: 24-week results support the safety of a 2-day break on efavirenz-based antiretroviral therapy. J Int AIDS Soc 2008;11(Suppl 1):019
    1. Parienti J-J, Bangsberg DR, Verdon R, et al. Better adherence with once-daily antiretroviral regimens: a meta-analysis. Clin Infect Dis 48:484–8
    1. McMahon JH, Jordan MR, Kelley K, et al. Pharmacy adherence measures to assess adherence to antiretroviral therapy: review of the literature and implications for treatment monitoring. Clin Infect Dis 2011;52:493–506
    1. Daar ES, Tierney C, Fischi MA, et al. Atazanavir plus ritonavir or efavirenz as part of a 3-drug regimen for initial treatment of HIV-1. Ann Intern Med 2011;154:445–56
    1. Riddler SA, Haubrich R, DiRienzo AG, et al. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med 2008; 358:2095–106
    1. Hellinger FJ, Encinosa WE. The cost and incidence of prescribing errors among privately insured HIV patients. Pharmacoeconomics 2010;28:23–34

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren