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  4. Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.
BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost
impacts of antiretroviral drugs by analysing a long-term follow-up
of direct costs for combined antiretroviral therapy, cART,
-regimens in the nationwide long-term observational multi-centre
German HIV ClinSurv Cohort. The second aim was to develop potential
cost saving strategies by modelling different treatment scenarios.
Antiretroviral regimens (ART) from 10,190 HIV-infected patients
from 11 participating ClinSurv study centres have been investigated
since 1996. Biannual data cART-initiation, cART-changes, surrogate
markers, clinical events and the Centre of Disease Control-
(CDC)-stage of HIV disease are reported. Treatment duration was
calculated on a daily basis via the documented dates for the
beginning and end of each antiretroviral drug treatment. Prices
were calculated for each individual regimen based on actual office
sales prices of the branded pharmaceuticals distributed by the
license holder including German taxes. During the 13-year follow-up
period, 21,387,427 treatment days were covered. Cumulative direct
costs for antiretroviral drugs of €812,877,356 were determined
according to an average of €42.08 per day (€7.52 to € 217.70).
Since cART is widely used in Germany, the costs for an entire
regimen increased by 13.5%. Regimens are more expensive in the
advanced stages of HIV disease. The potential for cost savings was
calculated using non-nucleotide-reverse-transcriptase-inhibitor,
NNRTI, more frequently instead of ritonavir-boosted protease
inhibitor, PI/r, in first line therapy. This calculation revealed
cumulative savings of 10.9% to 19.8% of daily treatment costs (50%
and 90% substitution of PI/r, respectively). Substituting certain
branded drugs by generic drugs showed potential cost savings of
between 1.6% and 31.8%. Analysis of the data of this nationwide
study reflects disease-specific health services research and will
give insights into the cost impacts of antiretroviral therapy, and
might allow a more rational allocation of resources within the
German health care system.

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„Calculation of direct antiretroviral treatment costs and potential cost savings by using generics in the German HIV ClinSurv cohort.“

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