Document Detail


Economic savings versus health losses: the cost-effectiveness of generic antiretroviral therapy in the United States.
MedLine Citation:
PMID:  23318310     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: U.S. HIV treatment guidelines recommend branded once-daily, 1-pill efavirenz-emtricitabine-tenofovir as first-line antiretroviral therapy (ART). With the anticipated approval of generic efavirenz in the United States, a once-daily, 3-pill alternative (generic efavirenz, generic lamivudine, and tenofovir) will decrease cost but may reduce adherence and virologic suppression.
OBJECTIVE: To assess the clinical effect, costs, and cost-effectiveness of a 3-pill, generic-based regimen compared with a branded, coformulated regimen and to project the potential national savings in the first year of a switch to generic-based ART.
DESIGN: Mathematical simulation of HIV disease.
SETTING: United States.
PATIENTS: HIV-infected persons.
INTERVENTION: No ART (for comparison); 3-pill, generic-based ART; and branded ART.
MEASUREMENTS: Quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICERs) in dollars per quality-adjusted life-year (QALY).
RESULTS: Compared with no ART, generic-based ART has an ICER of $21,100/QALY. Compared with generic-based ART, branded ART increases lifetime costs by $42,500 and per-person survival gains by 0.37 QALYs for an ICER of $114,800/QALY. Estimated first-year savings, if all eligible U.S. patients start or switch to generic-based ART, are $920 million. Most plausible assumptions about generic-based ART efficacy and costs lead to branded ART ICERs greater than $100,000/QALY.
LIMITATION: The efficacy and price reduction associated with generic drugs are unknown, and estimates are intended to be conservative.
CONCLUSION: Compared with a slightly less effective generic-based regimen, the cost-effectiveness of first-line branded ART exceeds $100,000/QALY. Generic-based ART in the United States could yield substantial budgetary savings to HIV programs.
PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases.
Authors:
Rochelle P Walensky; Paul E Sax; Yoriko M Nakamura; Milton C Weinstein; Pamela P Pei; Kenneth A Freedberg; A David Paltiel; Bruce R Schackman
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-15     Completed Date:  2013-03-11     Revised Date:  2014-04-22    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  84-92     Citation Subset:  AIM; IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adenine / analogs & derivatives,  economics,  therapeutic use
Anti-HIV Agents / economics*,  therapeutic use*
Benzoxazines / economics,  therapeutic use
Cost-Benefit Analysis
Deoxycytidine / analogs & derivatives,  economics,  therapeutic use
Drug Combinations
Drugs, Generic / economics*,  therapeutic use*
Female
HIV Infections / complications,  drug therapy*
Humans
Male
Models, Theoretical
Organophosphonates / economics,  therapeutic use
Quality-Adjusted Life Years
Reverse Transcriptase Inhibitors / economics,  therapeutic use
United States
Grant Support
ID/Acronym/Agency:
P30 AI060354/AI/NIAID NIH HHS; P30 MH062294/MH/NIMH NIH HHS; R01 AI042006/AI/NIAID NIH HHS; R01 AI093269/AI/NIAID NIH HHS; R01-AI093269/AI/NIAID NIH HHS; R37 AI042006/AI/NIAID NIH HHS; R37-AI42006/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/Benzoxazines; 0/Drug Combinations; 0/Drugs, Generic; 0/Organophosphonates; 0/Reverse Transcriptase Inhibitors; 0/emtricitabine; 0W860991D6/Deoxycytidine; 107021-12-5/tenofovir; JAC85A2161/Adenine; JE6H2O27P8/efavirenz
Comments/Corrections
Comment In:
Ann Intern Med. 2013 May 21;158(10):776-7   [PMID:  23689770 ]
Ann Intern Med. 2013 May 21;158(10):776   [PMID:  23689769 ]
Ann Intern Med. 2013 Jan 15;158(2):133-4   [PMID:  23318314 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Accuracy of electronically reported "meaningful use" clinical quality measures: a cross-sectional st...
Next Document:  Selective D-dimer testing for diagnosis of a first suspected episode of deep venous thrombosis: a ra...