This year, the United States will spend nearly $15 billion on HIV care and medication, yet funding shortfalls mean that more than 2,000 patients are on waiting lists for antiretrovirals. However, this situation could change in the next few years, as US patents on several blockbuster HIV drugs begin to expire.
At last month’s 19th International AIDS Conference, Rochelle Walensky, an infectious-disease physician at Massachusetts General Hospital, presented research regarding the cost-effectiveness of switching patients from Gilead Science’s Atripla, a three-in-one HIV pill, to a combination of two generic drugs (generic lamivudine for emtricitabine; and efavirenz, which is expected to be available as a generic in 2013) and the brand-name drug tenofovir.
The study showed the switch would save the United States a projected $920 million in the first year alone. The replacement could be slightly less effective than Atripla, because patients are more likely to skip doses when they have to swallow several pills. But the difference is small, according to Walensky: Staying with Atripla might add 4.4 months to a patient’s life, but $42,500 to their bill. The trade-off, she said, would be between slightly less-effective treatment for the individual but greater access to care for HIV-positive people overall.
“Although there’s a convenience factor to having one pill once a day, if the trade-off is many people having no access to medication, then it’s better to split up the pill or use the threat of splitting it to get Gilead to reduce their prices,” said Michael Weinstein, president of the AIDS Healthcare Foundation.
Brand-name drug companies have said a widespread switch to generic antiretroviral drugs could inhibit the development of new HIV drugs. However, with so many drugs going off-patent, John Bartlett, an infectious-disease researcher at Johns Hopkins Bloomberg School of Public Health, predicted, “In ten years, this will be a disease treated for $200 per year, or less.”
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