.png?auto=format "help hiv patients")
.png?auto=format "help hiv patients")
What Is Inadequate Control of HIV Costing Your Plan?
Achieving viral suppression and preventing HIV transmission are key treatment goals for patients with HIV.1
And yet,
of patients diagnosed with HIV fail to achieve viral suppression,
according to the Centers for Disease Control and Prevention.2
There are several factors that may result in additional HIV-related costs for payers3-5:
- Drug-resistant mutations
- Suboptimal adherence
- Increased disease progression
The DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents recommends providers tailor HIV treatment regimens to an individual’s needs.1
Open access to all HIV treatment regimens is important to help providers offer patients the tailored care they need.
Why Do So Many Patients With HIV Fail to Achieve Viral Suppression?
Despite best efforts from providers, 35% of patients diagnosed with HIV fail to achieve viral suppression.1 Some reasons why patients with HIV may be inadequately controlled include1:
Inadequately Controlled HIV and Increased Costs: What Does This Mean for Payers?
Healthcare resource utilization (HCRU) and cost of care may significantly increase for HIV patients who are not adequately controlled.4,5
Decreasing CD4 counts are a predictor of HIV disease progression, which may lead to worsening health and increased costs.
In one study, patients with CD4 counts <200 cells/mm3 incurred 51% higher all-cause total costs than patients with CD4 >500 cells/mm3, and their medical costs were 207% higher, driven primarily by inpatient healthcare costs.4*
*This retrospective cohort study of a large US claims database used administrative claims representing more than 70 million lives in the US between July 1, 2013, and March 31, 2019, including medical and pharmacy claims. A total of 5,522 patients met the study criteria including: 1,117 heavily treatment-experienced, 2,394 treatment-experienced, and 2,011 treatment-naïve HIV patients. All study measures were summarized by CD4 count strata, <200, 200-500, or >500 cells/mm3.
The Following Factors Result in Additional HIV-Related Costs for Payers:
Emergence of drug-resistant mutations
When patients fail to achieve and maintain viral suppression, drug-resistant mutations may occur, compromising future treatment options.1,3
Increased disease progression due to CD4 counts
Patients with CD4 counts <200 cells/mm3, a predictor of HIV progression and survival, have been shown to experience more HIV-related conditions, higher mortality risk, and increased HCRU and costs.1,3,4
Suboptimal adherence
In a Magellan retrospective claims study, commercially insured patients with HIV with at least 3 years of follow-up who experienced suboptimal adherence (PDC <95%) were more likely to incur greater annual medical costs, excluding pharmacy costs, compared with patients with high adherence (PDC ≥95%) ($8,224 vs $3,097; P=0.0007).5†
†A retrospective cohort design of members living with HIV (N=2,030) was implemented using data from Magellan Health, Inc, a medical and pharmacy administrative claims database from multiple region health plans (Medicaid and commercial) in the United States between January 1, 2007, and June 30, 2016. Each patient was categorized on the basis of ART regimen pill burden. In the healthcare cost analyses, commerically insured patients were further divided into 2 cohorts on the basis of length of available follow-up data (<3 or ≥3 years). Adherence to ART medication (mean PDC) during the first 15 months was lower in Medicaid patients (65%) versus commercially insured patients (79%; P<0.0001). Medical costs included inpatient, outpatient, laboratory, emergency department, and other costs.
Why ART Choices Matter for Providers
The DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents recommends providers consider a variety of factors to help patients with HIV achieve viral suppression and prevent HIV transmission1:
- Virologic efficacy and increased disease progression due to lower CD4 counts
- Adherence issues due to pill burden, tolerability and toxicity, dosing frequency, potential drug-drug interactions, and intermittent access to ART
- Age and comorbidities such as cardiovascular disease, renal and liver disease, mental illness, and substance abuse
- Cost of care given that patients require lifelong ART
Adherence to ART is crucial to achieving virologic suppression and minimizing drug resistance.1
Single-Tablet Regimens (STRs): An Option for Higher Adherence and Better Virologic Control
STRs offer patients a once-a-day option to achieve and maintain adequate viral suppression.1 Several studies have shown that once-a-day regimens may help improve patient adherence due to lower pill burden and provide better virologic control in patients with HIV.6-8
Patients with HIV taking an STR demonstrated high adherence
Adherence to ART is critical to maintaining adequate HIV control.1 One study demonstrated that patients with HIV on an STR experienced high adherence compared with patients on a multi-tablet regimen (MTR) (75% vs 56%; P<0.001).6,7‡
‡A retrospective cohort study of patients (N=15,602) at the Veterans Healthcare Administration between January 1, 2006, and July 30, 2012. Patients were followed from the index date until treatment discontinuation, end of study period, last date of healthcare-related activity, or death. High adherence was defined as a medication possession ratio of ≥95%.
STRs may offer better virologic control compared with MTRs
In a retrospective cohort study of treatment-naïve patients, initiation and maintenance of an STR was associated with undetectable HIV viral load after ART initiation compared with MTRs at 12 months (82% vs 66%, P=0.019).8§
§A retrospective cohort study of treatment-naïve patients (N=218) at an urban HIV clinic in the United States between 2006 and 2013 from multiple health plans (Medicaid, Medicare, commercial, self-pay, and hospital-based charity care). Patients were started on an STR or MTR as chosen by their provider, and continued on an uninterrupted and unchanged regimen for a minimum of 6 months. Patients switching therapy after 6 months were included in the study. Patients were assessed for viral load suppression at 6 and 12 months after initiating either an STR or MTR.
Open access to all ART regimens is important.
Help providers offer HIV patients the tailored care they need.
DHHS=Department of Health and Human Services; PDC=proportion of days covered.
References:
1. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. US Department of Health and Human Services. Updated February 24, 2021. Accessed May 25, 2021. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/AdultandAdolescentGL.pdf
2. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2018. HIV Surveillance Supplemental Report. 2020;25(2). Published May 2020. Accessed May 25, 2021. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
3. Gebo KA, Fleishman JA, Conviser R, et al. Contemporary costs of HIV healthcare in the HAART era. AIDS. 2010;24(17):2705-2715. doi: 10.1097/QAD.0b013e32833f3c14
4. Priest J, Hulbert E, Gilliam B, Burton T. Health care resource utilization and cost of people living with HIV (PLWH) in US commercial and Medicare Advantage health plans. Poster presented at: IDWeek 2020; October 21-25, 2020; Virtual.
5. Kangethe A, Polson M, Lord TC, Evangelatos T, Oglesby A. Real-world health plan data analysis: key trends in medication adherence and overall costs in patients with HIV. J Manag Care Spec Pharm. 2019;25(1):88-93. doi: 10.18553/jmcp.2019.25.1.088.
6. Sutton SS, Hardin JW, Bramley TJ, D’Souza AO, Bennett CL. Single- versus multiple-tablet HIV regimens: adherence and hospitalization risk. Am J Manag Care. 2016;22(4):242-248.
7. Sutton SS, Magagnoli J, Hardin JW. Impact of pill burden on adherence, risk of hospitalization, and viral suppression in patients with HIV infection and AIDS receiving antiretroviral therapy. Pharmacotherapy. 2016;36(4):385-401. doi: 10.1002/phar.1728.
8. Kapadia SN, Grant RR, German SB, et al. HIV virologic response better with single-tablet once daily regimens compared to multiple-tablet daily regimens. Sage Open Med. 2018;6:1-8. doi:10.1177/2050312118816919
HVUWCNT210007 August 2021
