Budget impact of a set-dose combination of efavirenz-emtricitabine-tenofovir in the treatment of patients infected with HIV-1

Oyagüez, Itziar; Casado, Miguel A.; Cotarelo, Manuel; Ramírez-Arellano, Antonio; Mallolas, Josep

doi:10.1016/S2173-5085(09)70090-5

Farmacia Hospitalaria

ISSN: 1130-6343

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We developed a budgetary impact model with pharmacological costs for the different currently available treatment options, based on GeSida's recommended guidelines for treating HIV-positive patients. The model defines 5 possible scenarios in which various possibilities for substituting different drug cocktails with the efavirenz-emtricitabine-enofovir combination are contemplated.

Results

The investment per patient on a national level amounts to €7989 in the base scenario (without considering the availability of the efavirenz-emtricitabine-tenofovir combination) and to €7997, €8424, €7830, €8375, and €8527 for scenario 1 (substitution of recommended drugs with efavirenz, emtricitabine, and tenofovir or efavirenz, lamivudine, and tenofovir); scenario 2 (substitution of recommended drugs with efavirenz); scenario 3 (substitution of recommended drugs with tenofovir); scenario 4 (substitution of recommended drugs with tenoforvir or zidovudine); and scenario 5 (total substitution), respectively. Compared with the base scenario this means increments of 0.11%, 5.45%, −1.99%, 4.83%, and 6.73% for scenarios 1, 2, 3, 4, and 5.

Conclusion

Use of a set combination of efavirenz, emtricitabine and tenofovir to treat adult patients with the HIV-1 virus would lead to slight surpluses or even budgetary savings by decreasing the number of daily doses, which could increase patients’ quality of life and help them stay on the treatment properly.

Keyword:

Budgetary impact

Efavirenz

Emtricitabine

Tenofovir

HIV-positive patients

Resumen

Objetivo

Estimación del impacto presupuestario de la utilización de la combinación fija de efavirenz-emtricitabina-tenofovir en el tratamiento de pacientes infectados por el virus de la inmunodeficiencia humana tipo 1 (VIH-1) para el Sistema Nacional de Salud en España, y evaluación de la repercusión para cada comunidad autónoma en el año 2008.

Métodos

Se ha desarrollado un modelo de impacto presupuestario con los costes farmacológicos de las alternativas terapéuticas actualmente disponibles, a partir de las pautas recomendadas por GeSida para el tratamiento de la infección por el VIH-1. En el modelo se han definido 5 posibles escenarios en los que se asumen diferentes posibilidades de sustitución de las distintas asociaciones terapéuticas por la combinación efavirenz + emtricitabina + tenofovir.

Resultados

La inversión por paciente en el ámbito nacional supone un coste de 7.989 € en el escenario base (sin considerar disponibilidad de la combinación efavirenz-emtricitabina-tenofovir) y de 7.997, 8.424, 7.830, 8.375 y 8.527 € para los escenarios 1 (sustitución de pautas con efavirenz, emtricitabina, tenofovir o efavirenz, lamivudina, tenofovir), 2 (sustitución de pautas con efavirenz), 3 (sustitución de pautas con tenofovir), 4 (sustitución de pautas con tenofovir o zidovudina) y 5 (sustitución total), respectivamente, lo que se traduce en incrementos respecto al escenario base del 0,11, 5,45, −1,99, 4,83 y 6,73% para los escenarios 1, 2, 3, 4 y 5, respectivamente.

Conclusión

La utilización de la combinación fija de efavirenz-emtricitabina-tenofovir en el tratamiento de pacientes adultos infectados por el VIH-1 conllevaría ligeros incrementos o incluso ahorros presupuestarios, con disminución del número de tomas diarias, lo que podría mejorar la calidad de vida de los pacientes, el cumplimiento y la adherencia al tratamiento.

Palabras clave:

Impacto presupuestario

Efavirenz

Emtricitabina

Tenofovir

Pacientes infectados por el VIH

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