Physicians’ opinions on generic antiretroviral drugs and single-tablet regimen de-simplification for the treatment of HIV infection: a multicentre survey in Spain

Abstract

Objectives To assess the attitudes and opinions about generic antiretroviral drugs (ARVs) and single-tablet regimen (STR) de-simplification among physicians prescribing HIV treatment in the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods An online questionnaire with 27 structured questions was sent to all physicians (n = 199) who prescribed ARVs among the 45 centres participating in the cohort. Results A total of 169 (84.9%) physicians answered the questionnaire. Only 4.1% of the physicians would never prescribe generic ARVs, but 53.3% would not prescribe them if the number of pills per day increased and 89.3% would not prescribe them if the number of doses per day increased. However, 84.0% of the physicians agreed to prescribe generic ARVs if doing so would decrease costs for the public healthcare system. The percentages of physicians stating that generic ARVs (compared with branded ones) would be associated with worse adherence, more adverse effects or more probability of virological failure, provided that the number of pills and doses per day would not change, were low: 0.6%, 7.7% and 3.6%, respectively. However, these percentages were much higher if the generic ARV entailed breaking an STR: 63.9%, 18.9% and 42.0%, respectively. Most physicians stated that they needed more information about the effectiveness and safety of generic ARVs and the price difference compared with their branded equivalents. Conclusions Although most physicians were confident about prescribing generic ARVs, the majority had strong concerns about de-simplifying STR, and they also needed more information about generic drugs.

De-simplifying single-tablet antiretroviral treatments for cost savings in France: From the patient perspectives to a 6-month follow-up on generics

“…This result shows however even better acceptability than the one estimated in 2013 in a French study of PLWHA showing that generic ARVs would be accepted by 44% of them but only by 17% if the pill burden was going to increase [13]. Although most physicians are confident about prescribing generic ARVs, some need more information about generic drugs [14]. Efficient information programs for patients and physicians may alleviate concerns surrounding generic substitution.…”

Effectiveness and tolerability of dolutegravir and abacavir/lamivudine administered as two separate pills compared to their equivalent single‐tablet regimen in a multicentre cohort in Spain

“…Based on the aforementioned studies, most clinicians caring for PLHIV are quite confident about prescribing generic ARVs, but they do not agree on de‐simplifying STRs and increasing the daily pill burden of ARVs [ 10 , 11 , 12 ]. However, most of these studies were done in the context of simplification strategies and did not compare STRs with their equivalent separate components, but rather with multiple‐tablet regimens that had different drug combinations, or even different ARV drug classes.…”

“…Therefore, changing branded STRs for their equivalent generic components often entails administering them as at least two separate pills (these changes are known as “de‐simplifying STRs” or “breaking the combos”). These changes are controversial, and several studies have shown that, while most HIV care clinicians agree on using generic ARVs to decrease healthcare costs, many of them do not agree to de‐simplify STRs, mainly because of concerns of potential decreased treatment adherence [ 10 , 11 , 12 ].…”

Past and future of HIV infection. A document based on expert opinion

“…A low CD4 cell count at diagnosis is associated with increased morbidity and mortality and higher costs. Patients with CD4 cell counts below 50 cells/microlitre generate a higher non-CART cost, which decreases substantially when CD4s increase above 100 cells/microlitre [31,48,51,[66][67][68][69][70][71][72].…”