Calculation of Direct Antiretroviral Treatment Costs and Potential Cost Savings by Using Generics in the German HIV ClinSurv Cohort.
Creators: name: Stoll, Matthias
name: Kollan, Christian
name: Bergmann, Frank
name: Bogner, Johannes
name: Faetkenheuer, Gerd
name: Fritzsche, Carlos
name: Hoeper, Kirsten
name: Horst, Heinz-August
name: Lunzen, Jan Van
name: Plettenberg, Andreas
name: Reuter, Stefan
name: Rockstroh, Jürgen
name: Stellbrink, Hans-Jürgen
name: Hamouda, Osamah
name: Bartmeyer, Barbara
Publisher: name: Robert Koch-Institut, Infektionsepidemiologie
Year: 2011
Subjects: subject: Adult
subject: Humans
subject: Female
subject: Germany
subject: Male
subject: Cohort Studies
subject: HIV Infections/drug therapy
subject: Reverse Transcriptase Inhibitors/therapeutic use
subject: Follow-Up Studies
subject: Reverse Transcriptase Inhibitors/pharmacology
subject: Anti-HIV Agents/therapeutic use
subject: Anti-HIV Agents/economics
subject: Anti-HIV Agents/pharmacology
subject: Cost Savings/statistics &amp; numerical data
subject: Drug Prescriptions/economics
subject: Drug Prescriptions/statistics &amp; numerical data
subject: Drug Therapy Combination/economics
subject: Drugs Generic/economics
subject: Drugs Generic/pharmacology
subject: Drugs Generic/therapeutic use
subject: HIV Reverse Transcriptase/antagonists &amp; inhibitors
subject: Protease Inhibitors/economics
subject: Protease Inhibitors/pharmacology
subject: Protease Inhibitors/therapeutic use
subject: Reverse Transcriptase Inhibitors/economics
subject: 610 Medizin

description: Background/Aim of the Study: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a longterm follow-up of direct costs for combined antiretroviral therapy, cART,-regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios. Methods: Antiretroviral regimens (ART) from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART,-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC)-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes. Results: During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of J812,877,356 were determined according to an average of J42.08 per day (J7.52 to J 217.70). Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptaseinhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively). Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%. Conclusions: Analysis of the data of this nationwide study reflects disease-specific health services research and will give insights into the cost impacts of antiretroviral therapy, and might allow a more rational allocation of resources within the German health care system.