Featured Research

from universities, journals, and other organizations

Generic HIV treatment strategy could save nearly $1 billion annually but may be less effective

Date:
January 14, 2013
Source:
Massachusetts General Hospital
Summary:
Replacing the combination of brand-name, antiretroviral drugs currently recommended for control of HIV infection with soon-to-be-available generic medications could save the US health care system almost $1 billion a year but may diminish the effectiveness of HIV treatment.

Replacing the combination of brand-name, antiretroviral drugs currently recommended for control of HIV infection with soon-to-be-available generic medications could save the U.S. health care system almost $1 billion a year but may diminish the effectiveness of HIV treatment. A study led by Massachusetts General Hospital (MGH) investigators, appearing in the January 15 Annals of Internal Medicine, examines the potential impact of such a change.

"The switch from branded to generic antiretrovirals would place us in the uncomfortable position of trading some losses of both quality and quantity of life for a large potential dollar savings," says Rochelle Walensky, MD, MPH, of the MGH Medical Practice Evaluation Center, lead author of the study. "By estimating the likely magnitude of these offsetting effects now -- before generic antiretrovirals actually hit the shelves -- we can confront our willingness as clinicians, patients and as a society to make these difficult choices."

In 2011 the cost of antiretroviral drugs in the U.S. was around $9 billion, most of which was paid for by government sources. The currently recommended treatment for newly diagnosed patients is a single pill (Atripla) taken daily that combines three brand-name antiretrovirals: tenofovir (Viread), emtricitabine (Emtriva) and efavirenz (Sustiva). A generic form of the antiretroviral drug lamivudine, which has a similar mechanism of action to emtricitabine, became available in January 2012, and a generic version of efavirenz is expected in the relatively near future.

Replacing two of the three branded drugs with generics could significantly reduce costs, the authors note, but such a strategy would also have disadvantages. A more complicated treatment regimen, requiring three daily pills instead of one, increases the risk that some patients will miss doses, leading to the loss of antiretroviral effectiveness called treatment failure. Laboratory studies have also found that lamivudine may be slightly less effective and more vulnerable to the development of drug-resistant viral strains than emtricitabine.

To evaluate the impact of a switch to a generic-based antiretroviral regimen, the research team used a widely used mathematical model of HIV progression to simulate the effects of a daily three-pill regimen of generic efavirenz and lamivudine plus brand-name tenofovir, compared with the current one-pill combination drug. They adopted a worst-case scenario to project the efficacy of the generic drugs and their impact on viral resistance.

Their results indicated that switching all HIV-infected patients in the U.S. to the three-drug generic strategy would produce lifetime savings of $42,500 per eligible patient. In the first year alone, the nationwide savings would reach nearly $1 billion. However, the quality-adjusted loss of life expectancy could be as much as 4.5 months.

The study's senior author, Bruce Schackman, PhD, associate professor of Public Health at Weill Cornell Medical College, says, "Diverting patients from the most effective, branded treatment alternative could be made more acceptable if the savings were directed to other HIV-related needs. For example, fewer than half the state-funded AIDS Drug Assistance Programs include the effective protease-inhibitor-based treatment for hepatitis C virus (HCV), which infects up to 25 percent of HIV-infected individuals. We calculated that, for every 15 patients switched to the generic-based regimen, one who is also infected with HCV could be treated and potentially cured of that infection."

Adds Walensky, a professor of Medicine at Harvard Medical School, "For patients who take their medications well and adhere to the medical regimen, the generic option will be a bit more complex but could be as effective as the standard regimen. But a patient who relies heavily on the simplicity of taking a single pill is more likely to suffer detrimental effects, since missing doses will increase the risk of treatment failure.

"There's no getting around the fact that savings from generics will only be realized if we deliberately route patients away from the most effective, branded treatment alternative," she stresses. "This is a trade-off that many of us will find emotionally difficult, and perhaps even ethically impossible, to recommend. All of us -- consumers, providers and advocates -- would be far likelier to embrace such a policy change if we knew the savings would be redirected towards other aspects of HIV medicine."

Additional co-authors of the Annals report are Yoriko Nakamura, Pamela Pei, PhD, and Kenneth Freedberg, MD, MSc, MGH Medical Practice Evaluation Center; Paul Sax, MD, Brigham and Women's Hospital; Milton Weinstein, PhD, Harvard School of Public Health; and David Paltiel, PhD, Yale School of Medicine.. The study was supported by grants from the National Institute for Allergy and Infectious Disease.


Story Source:

The above story is based on materials provided by Massachusetts General Hospital. Note: Materials may be edited for content and length.


Journal Reference:

  1. Rochelle P. Walensky et al. Economic Savings Versus Health Losses: The Cost-Effectiveness of Generic Antiretroviral Therapy in the United States. Annals of Internal Medicine, January 2013

Cite This Page:

Massachusetts General Hospital. "Generic HIV treatment strategy could save nearly $1 billion annually but may be less effective." ScienceDaily. ScienceDaily, 14 January 2013. <www.sciencedaily.com/releases/2013/01/130114172056.htm>.
Massachusetts General Hospital. (2013, January 14). Generic HIV treatment strategy could save nearly $1 billion annually but may be less effective. ScienceDaily. Retrieved April 20, 2014 from www.sciencedaily.com/releases/2013/01/130114172056.htm
Massachusetts General Hospital. "Generic HIV treatment strategy could save nearly $1 billion annually but may be less effective." ScienceDaily. www.sciencedaily.com/releases/2013/01/130114172056.htm (accessed April 20, 2014).

Share This



More Health & Medicine News

Sunday, April 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Nine-Month-Old Baby Can't Open His Mouth

Nine-Month-Old Baby Can't Open His Mouth

Newsy (Apr. 19, 2014) Nine-month-old Wyatt Scott was born with a rare disorder called congenital trismus, which prevents him from opening his mouth. Video provided by Newsy
Powered by NewsLook.com
'Holy Grail' Of Weight Loss? New Find Could Be It

'Holy Grail' Of Weight Loss? New Find Could Be It

Newsy (Apr. 18, 2014) In a potential breakthrough for future obesity treatments, scientists have used MRI scans to pinpoint brown fat in a living adult for the first time. Video provided by Newsy
Powered by NewsLook.com
Little Progress Made In Fighting Food Poisoning, CDC Says

Little Progress Made In Fighting Food Poisoning, CDC Says

Newsy (Apr. 18, 2014) A new report shows rates of two foodborne infections increased in the U.S. in recent years, while salmonella actually dropped 9 percent. Video provided by Newsy
Powered by NewsLook.com
Scientists Create Stem Cells From Adult Skin Cells

Scientists Create Stem Cells From Adult Skin Cells

Newsy (Apr. 17, 2014) The breakthrough could mean a cure for some serious diseases and even the possibility of human cloning, but it's all still a way off. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins