Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV
Open Access
- 1 July 2013
- Vol. 3 (8), e003028
- https://doi.org/10.1136/bmjopen-2013-003028
Abstract
Objectives Lower pill burden leads to improved antiretroviral therapy (ART) adherence among HIV patients. Simpler dosing regimens have not been widely explored in real-world populations. We retrospectively assessed ART adherence, all-cause hospitalisation risk and costs, and other healthcare utilisation and costs in Medicaid enrollees with HIV treated with ART as a once-daily single-tablet regimen (STR) or two or more pills per day (2+PPD). Design Patients with an HIV diagnosis from 2005 to 2009 receiving complete ART (ie, two nucleoside/nucleotide reverse transcriptase inhibitors plus a third agent) for ≥60 days as STR or 2+PPD were selected and followed until the first of (1) discontinuation of the complete ART, (2) loss of enrolment or (3) end of database. Adherence was measured using the medication possession ratio. Monthly all-cause healthcare utilisation and costs were observed from regimen initiation until follow-up end. Results Of the 7381 patients who met inclusion criteria, 1797 were treated with STR and 5584 with 2+PPD. STR patients were significantly more likely to reach 95% adherence and had fewer hospitalisations than 2+PPD patients (both p<0.01). STR patients had mean (SD) total monthly costs of $2959 ($4962); 2+PPD patients had $3544 ($5811; p<0.001). Hospital costs accounted for 53.8% and pharmacy costs accounted for 32.5% of this difference. Multivariate analyses found that STR led to a 23% reduction in hospitalisations and a 17% reduction in overall healthcare costs. ART adherence appears to be a key mechanism mediating hospitalisation risk, as patients with ≥95% adherence (regardless of regimen type) had a lower hospitalisation rate compared with <95% adherence. Conclusions While it was expected that STR patients would have lower pharmacy costs, we also found that STR patients had fewer hospitalisations and lower hospital costs than 2+PPD patients, resulting in significantly lower total healthcare costs for STR patients.Keywords
This publication has 27 references indexed in Scilit:
- Adherence to Antiretroviral Treatment and Correlation with Risk of Hospitalization among Commercially Insured HIV Patients in the United StatesPLOS ONE, 2012
- Pharmacy Adherence Measures to Assess Adherence to Antiretroviral Therapy: Review of the Literature and Implications for Treatment MonitoringClinical Infectious Diseases, 2011
- Antiretroviral Treatment of Adult HIV InfectionJama-Journal Of The American Medical Association, 2010
- One-pill once-a-day HAART: a simplification strategy that improves adherence and quality of life of HIV-infected subjectsPatient Preference and Adherence, 2010
- Simplification of Antiretroviral Therapy to a Single-Tablet Regimen Consisting of Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate Versus Unmodified Antiretroviral Therapy in Virologically Suppressed HIV-1-Infected PatientsJAIDS Journal of Acquired Immune Deficiency Syndromes, 2009
- Better Adherence with Once‐Daily Antiretroviral Regimens: A Meta‐AnalysisClinical Infectious Diseases, 2009
- Nonadherence Increases the Risk of Hospitalization Among HIV-Infected Antiretroviral Naïve Patients Started on HAARTJournal of the International Association of Physicians in AIDS Care, 2008
- Pharmacy-based assessment of adherence to HAART predicts virologic and immunologic treatment response and clinical progression to AIDS and deathInternational Journal of STD & AIDS, 2004
- Antiretroviral Therapy Adherence and Viral Suppression in HIV‐Infected Drug Users: Comparison of Self‐Report and Electronic MonitoringClinical Infectious Diseases, 2001
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987