Navigation Links
Generic HIV treatment strategy could save nearly $1 billion annually but may be less effective
Date:1/14/2013

NEW YORK (Jan. 14, 2013) -- 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) and Weill Cornell Medical College 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, chief of the Division of Health Policy and 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."


'/>"/>

Contact: Lauren Woods
Law2014@med.cornell.edu
646-317-7401
Weill Cornell Medical College
Source:Eurekalert

Related medicine news :

1. Plavixs New Generic Status Could Be Boon for Patients
2. FDA Approves Generic Versions of Plavix
3. Generic drugs key to US overseas HIV relief
4. Toward competitive generic drug prices in Canada
5. FDA Pulls One Generic Form of Wellbutrin Off the Market
6. Regenstrief study finds that generic drugs often have incorrect safety labeling
7. Inconsistency Seen in Safety Labeling for Generic Drugs
8. Differences in generic pill characteristics may lead to interruptions in essential medication use
9. People May Skip Generic Pills if Color Differs From Brand-Name Drug
10. 1/3 of Docs Often Prescribe Brand-Name Drugs Over Generics: Study
11. Scientist awarded $1 million grant to develop tools for hepatitis C treatment discovery
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2017)... ... , ... CareSet Labs released the Root NPI Graph today at the 2017 ... improved version of the Doctor Referral teaming dataset commonly available from Medicare. , Originally ... the the “Doctor Referral Dataset” as released by Medicare and “DocGraph” as released by ...
(Date:6/25/2017)... ... June 25, 2017 , ... June is Men’s Health Month and the focus is ... among men in the U.S. and the third most common cause of cancer related death ... man in seven will be diagnosed with prostate cancer during his lifetime. Those at ...
(Date:6/24/2017)... ... June 24, 2017 , ... The Pennsylvania Athletic Trainers’ Society’s ... and Erie Convention Center on June 8-10. The weekend consisted of many ... award and scholarship presentations, and professional networking. , On Friday June 9th, ...
(Date:6/24/2017)... , ... June 24, 2017 , ... The weather is ... time outdoors. Home and business owners should be aware that the summer months provide ... In fact, mechanical locks and keys can be negatively affected from direct exposure to ...
(Date:6/23/2017)... , ... June 23, 2017 , ... ... today announced the launch of Care Management Alerts and Dashboards, an innovative new ... throughout Rhode Island. , RIQI’s Care Management Alerts and Dashboards provide near real-time ...
Breaking Medicine News(10 mins):
(Date:6/14/2017)... Calif. , June 14, 2017 The ... the City of Fremont and ... of the bio-pharma industry in California ... technology, enabling executive networking, and fostering workforce development. The ... development and growth of start-ups, as well as small ...
(Date:6/13/2017)... -- Zimmer Biomet Holdings, Inc. (NYSE and SIX: ZBH), a ... Food and Drug Administration (FDA) has notified the Company that ... Zhejiang, China manufacturing facility has been ... clearance of the Warning Letter related to our ... of the progress we have made in our ongoing quality ...
(Date:6/11/2017)... and Company (NYSE: LLY ) announced today ... an investigational treatment for the prevention of episodic and ... endpoints for galcanezumab compared to placebo at both studied ... REGAIN) will be presented today at the American Headache ... . "The detailed Phase 3 ...
Breaking Medicine Technology: