Antiretroviral Treatment Switching: Clinical and Economic Impact Explored
Starting patients on an optimal antiretroviral (ART) regimen from the start reduces the need for switching, and may positively impact patients and healthcare systems overall, a study published in the Annals of Pharmacotherapy reported.
Jennifer S. Korsnes, MS,from RTI Health Solutions, and colleagues, searched administrative health claims to determine whether switching ART regimens was tied to greater healthcare costs, resource use, and adverse treatment effects. They identified commercially insured and Medicaid-enrolled patients with at least claims containing an HIV/AIDS diagnosis from 2006–2011 and received an ART prescription from 2007–2010.
During a 12-month follow-up period, treatment characteristics (eg, switching), adverse treatment effects, and healthcare resource utilization and costs were evaluated. The relationship between ART switching and economic outcomes (eg, costs, healthcare encounters) and adverse treatment effects were analyzed by multivariable models.
Of the total 14,590 commercially-insured patients who met the criteria, 12% had an ART switch; of the 5,744 Medicaid enrolled patients, 14% switched treatment.
Overall, ART switching was associated with a 64% and 36% (P<0.0001) increases in hospitalizations; 36% and 25% (P<0.0001) increases in non-pharmacy costs; and 15% and 8% (P<0.0001) increases in pharmacy costs among commercially insured and Medicaid enrolled patients, respectively.
Switching ART was also associated with a higher risk of adverse treatment effects, both overall and for specific conditions (eg, GI intolerance).
Study authors concluded that the findings suggest economic outcomes and certain adverse treatment effects associated with switching ART.
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