De‐simplifying single‐tablet antiretroviral treatments: uptake, risks and cost savings

Objectives As more HIV‐positive individuals receive antiretroviral therapy (ART), payers are seeking options for covering these increased and sustained drug costs. Strategic use of available generic antiretroviral (ARV) formulations may be feasible. De‐simplifying a single‐tablet co‐formulation (STF) into two or more tablets using both brand and generic drugs has been proposed. We determine if voluntary de‐simplification of one STF could be utilized as a cost‐saving strategy. We report on the challenges, uptake, outcomes and cost savings of this initiative. Methods Patients stable on the most commonly used STF (Triumeq®) were offered the option of remaining on Triumeq® or switching to generic abacavir/lamivudine and Tivicay® between 1 January 2015 and 1 January 2018; those starting ART consisting of abacavir/lamivudine/doulutegravir in the same period were offered the option of starting Triumeq® or generic abacavir/laminvudine and Tivicay®. No incentives were provided. We examined the acceptance/decline rates, patient satisfaction, health care outcomes and annual cost savings. Results Of 626 patients receiving Triumeq®, 321 were approached; 177 (55.1%) agreed to de‐simplify. Of patients initiating ART, 62.7% chose the generic co‐formulation. Patients switching to or starting on the generic co‐formulation were more likely to be male, > 45 years old, Caucasian, men who have sex with men (MSM) and more HIV‐experienced, and to have more comorbidities (all P 500 HIV‐1 RNA copies/mL after baseline was 2.7% in switched patients compared with 7.0% in those declining to switch. No de novo resistance occurred. A saving of Cdn$1 319 686 was achieved in the first year. Conclusions Reliance on altruism, while respecting patient autonomy, achieved de‐simplification in > 50% of patients approached, and generated immediate cost savings with no increased risk of adverse events, viral breakthrough or resistance.