HIV-infected patients may soon be able to switch from a branded one-pill combination of antiretroviral drugs to a less expensive protocol that combines generic and branded drugs. Current guidelines recommend HIV-infected people take the single-pill combination of efavirenz (Sustiva), emtricitabine (Emtriva), and tenofovir (Atripla). The cheaper three-pill regimen would include a generic version of efavirenz, lamivudine (similar to emtricitabine), and Atripla. According to Rochelle Walensky, MD, the United States could see a savings of $920 million in the first year if every US resident on antiretroviral therapy switched to the three-pill generic regimen.
However, Walensky noted that it is harder to adhere to the schedule of taking three pills, and lack of adherence can make treatment less effective. In addition, there is evidence that lamivudine is less effective than emtricitabine, and patients are more likely to develop resistance to lamivudine.
Massachusetts General Hospital researchers compared the cost and effectiveness of no treatment with the recommended single pill dose, a three-pill regimen, and an intermediate treatment consisting of two pills. The two-pill alternative would include a generic form of efavirenz and a branded combination of tenofovir and emtricitabine (Truvada). An HIV-infected person who receives no treatment from age 43 has a life expectancy of 4.05 quality-adjusted life-years (QALY). The branded single-pill treatment results in 12.45 QALY, compared with 12.25 QALY for the two-pill intermediate treatment, and 12.08 QALY for the three-pill generic treatment.
Lifetime cost for the person taking the branded one-pill dose is $342,800, whereas lifetime cost for the generic-based three-pill regimen is estimated to be $300,300.
The full report, “Economic Savings Versus Health Losses: The Cost-Effectiveness of Generic Antiretroviral Therapy in the United States,” was published in the journal Annals of Internal Medicine (2013; 158(2):84–92).
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