Marseille 2007
Marseille 2007
Abstract book
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Abstract #415  -  Cost Comparison in Antiretroviral Nave Patients Who Fail with and without Resistance
Session:
  11.6: Cost (Parallel) on Monday @ 11.00-12.30 in HC Chaired by Eileen Stillwaggon, Didier Fassin
Authors:
  Presenting Author:   Mrs Sabina Haberlen - Johns Hopkins Bloomberg School of Public Health, United States
 
  Additional Authors:  Dr David Bishai, Dr Lisa Spacek, Dr Richard Moore,  
Aim:
Virological failure (VF) can be costly. Virological failure accompanied by drug resistance may be even more costly. We estimated the medical costs for patients with no VF and for those with and without genotypic resistance.
 
Method / Issue:
A retrospective cohort study of antiretroviral (ARV) nave patients from the John Hopkins Hospital HIV Clinic database receiving their initial ARV regimen between 1997 and 2005. Patients included had at least one clinic visit within 6 months after initiation of either a lopinavir/ritonavir (LPV/RTV) or an efavirenz (EFV) based regimens. Only patients with non-zero, non-missing data on drug use were included. Patients were divided into two groups (Non-VF and post-VF) using viral loads and genotypic results. VF was defined as two viral load measurements >1000 copies/ml. The costs in VF group were further defined as pre-VF and post-VF. The post-VF group was further defined as the cost in 1) VF without resistance; 2) VF with protease (PR) resistance (defined as at least one primary PI mutation based on IAS USA guidelines) and 3)VF with non-nucleoside reverse transcriptase (NNRT) resistance. Wholesale drug prices and Medicaid reimbursement rates for laboratory tests and consultations were multiplied by utilization markers to estimate costs as laboratory costs, drug costs, outpatient consults, and inpatient stays. Generalized linear models (GLM) accounted for skewness in costs by using a log link function to regress costs against dummies for each category
 
Results / Comments:
Of 1795 patients screened, 507 were eligible for inclusion. Of those, 77 patients received LPV/RTV and 430 received EFV as part of their initial treatment. Person and (person months) of observation for Non-VF, Post-VF without resistance, VF with PR resistance, and VF with NNRT resistance were respectively: 394 (12,356), 102 (1,622), 2 (41), and 9 (244). Monthly drug costs were $1,443 for Non-VF, $1,550 for VF without resistance, $1,778 for VF with PR resistance, and $2,148 for VF with NNRT resistance. Total monthly costs (including hospitalizations)were $1,449 for Non-VF, $4,501 for VF without resistance, $2,234 for VF with PR resistance, and $6,277 for VF with NNRT resistance.
 
Discussion:
Virologic failure was relatively uncommon in our clinic. Overall, patients with VF had higher drug utilization and costs than patients with no failure. Drug costs were highest in patients who developed resistance to antiretroviral drugs. Total cost estimates that include hospitalization should be interpreted with caution because hospitalizations are relatively rare events. Additional analyses with larger cohorts will be useful to further characterize the impact of resistance on cost of care in other settings.
 
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