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Abstract
Objectives: This study compared healthcare utilization and costs associated with switching the first-line protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) based antiretroviral (ARV) regimen due to reasons other than virologic failure among patients with HIV-1.
Methods: This was a retrospective analysis of commercial and Medicare Advantage with Part D enrollees in two US administrative claims databases. The study population comprised adults with HIV-1 infection initiating antiretroviral therapy (ART) on PI- or NNRTI-containing regimens from 1 January 2006 to 31 December 2015. Patients with a subsequent change in anchor agent were assigned to the switch cohort; the non-switch cohort was constructed using propensity score matching of three non-switching patients for each patient in the switch cohort. Patient characteristics and per patient per month healthcare resource utilization and costs were compared between the cohorts during the pre-switch, switch (15 days before and after switching) and post-switch periods. Costs during the switch period were also estimated with a multivariable-adjusted model.
Results: The matched study population consisted of 1204 patients who switched their first-line PI- or NNRTI-based regimen and 3612 patients who did not. Compared with the non-switch cohort, patients who switched had higher healthcare resource utilization during the pre-switch, switch and post-switch periods. Mean unadjusted non-ART costs in the switch cohort were nearly double ($2944 versus $1530, p < .001), more than double ($2562 versus $1215, p < .001) and 1.5 times higher ($1473 versus $968, p < .001) than costs in the non-switch cohort in the pre-switch, switch and post-switch periods, respectively.
Conclusions: Patients with HIV-1 who initiated PI- or NNRTI-based regimens and switched ARTs for reasons other than virologic failure used more healthcare resources and incurred greater costs relative to patients in the non-switch cohort. This study highlights the importance of initiating patients on appropriate first-line ART to avoid the need to switch due to reasons other than virologic failure.
Transparency
Declaration of funding
Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA.
Author contributions: J.M. and A.B. contributed to the conception and design of the study, all authors contributed to the analysis and interpretation of data, all authors contributed to drafting of the manuscript and revising it critically for intellectual content, and all authors provided final approval of the version to be published. All authors agree to be accountable for all aspects of the work.
Declaration of financial/other relationships
J.M. has disclosed that she was an employee of Optum at the time the study was conducted and is currently an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA. M.P.J. and J.T.M. have disclosed that they are employees of Optum and were funded by Merck & Co. Inc. to conduct the study. G.P. and A.B. have disclosed that they are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA. One peer reviewer is a full-time employee of Bristol-Myers Squibb and a Bristol-Myers Squibb shareholder. CMRO peer reviewers on this manuscript on this manuscript have no other relevant financial or other relationships to disclose.
Acknowledgements
Medical writing and/or editorial assistance was provided by Deja Scott-Shemon MPH, an employee of Optum. This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA. The authors would like to thank Shiqiang Li, Scott Bunner and Timothy Bancroft, all employees of Optum, for their help in creating study variables and datasets.