Calculation of Direct Antiretroviral Treatment Costs and Potential Cost Savings by Using Generics in the German HIV ClinSurv Cohort

Abstract

Background/Aim of the StudyThe study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term 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.MethodsAntiretroviral 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.ResultsDuring the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 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-transcriptase-inhibitor, 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%.ConclusionsAnalysis 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.

The choice between a ritonavir-boosted protease inhibitor- and a non-nucleoside reverse transcriptase inhibitor-based regimen for initiation of antiretroviral treatment – results from an observational study in Germany

“…Our results confirm earlier research that observes a relatively low proportion of patients with a NNRTI-based first-line cART in Germany in comparison to other countries [32], although most NNRTI-based treatment regimens are significantly cheaper than PI/r-based ones. From the 133 patients receiving antiretroviral first-line therapy, only 34.6% received a NNRTI-based cART regimen.…”

Fehlkodierungen von HIV/AIDS-Diagnosen und deren Bedeutung für den morbiditätsorientierten Risikostrukturausgleich

“…18 000 € für die ARM geschätzt werden. So ergab die Auswertung der deutschen Clin-Surv-Kohorte mit über 16 000 HIV-infizierten Patienten für das Jahr 2008 ARM-Kosten in Höhe von 18 268 € (Apothekenverkaufspreis ohne Kassenrabattierung) [13]. Eine weitere multizentrische Studie mit 518 Patienten ermittelte für die Jahre 2006 bis 2009 durchschnittliche jährliche Kosten der ARM in Höhe von 18 600 € aus gesellschaftlicher Perspektive und 17 045 € aus GKV-Perspektive [14].…”

Budget Impact Analysis Highlighting the Cost-Saving Potential of Generic Tenofovir Disoproxil Based Antiretroviral Therapy in Comparison with Tenofovir Alafenamide Based Treatment Regimens in the German Healthcare System

“…By significantly reducing HIV-associated morbidity and mortality, a sustainable reduction of costs could be achieved. As a result however, cART has become the dominant cost factor and has increased up to 85% of direct costs of disease for HIV infection in Europe [2][3][4][5].…”

“…A majority of initially availablegeneric drugs, i.e., zidovudine, nevirapine and efavirenz are no longer recommended as a preferred option in current national [9] and international [10,11] treatment guidelines. Their market share has therefore declined and budget impact has remained lower than predicted [2]. Meanwhile, generic tenofovir disoproxil (Gx-TD), a tenofovir prodrug, and emtricitabine (Gx-FTC) became available in August 2017.…”