Featured news from NHIVNA
HIV-related news from NAM
Switching from Atripla to generic-containing regimens can produce large cost savings
Michael Carter, 2017-04-23 07:20:00
branded Atripla to regimens that
include at least one generic drug formulation can achieve big cost savings
without compromising virological efficacy, according to research from Brighton
presented to the recent conference of the British HIV Association (BHIVA) in
The study involved 86 people who switched from one-pill Atripla to multi-pill combinations that
included at least one generic. The annual cost saving associated with the
treatment switch was £159,000. The vast majority of that saving resulted from switching to a combination of tenofovir, generic efavirenz and generic lamivudine. All the study participants who switched maintained an undetectable
viral load and only one person discontinued their new regimen because of pill
Atripla combines efavirenz,
emtricitabine and tenofovir in a single pill taken once daily. Its potency,
convenience and relative safety meant that it was, for a long time, the preferred drug
for first-line HIV therapy. Although it has now been supplanted by alternative
regimens, it continues to be taken by a large number of people.
Efavirenz is now
available as a generic, as is lamivudine, which is similar to emtricitabine in
its chemical make-up and anti-HIV activity. Given the considerable pressure on
the NHS and HIV services to save money, pharmacists and clinicians in Brighton
undertook a study to calculate the cost-savings that could be achieved by
people switching from branded Atripla
to multi-drug regimens incorporating at least one generic drug and to assess
the safety and durability of these alternative combinations.
review of notes and pharmacy data identified 428 people, who between August
2015 and March 2017, were being prescribed Atripla and had no clinical reason to change this therapy. Of these, 268 had been referred to a pharmacist to discuss switching to one of two generic-containing regimens:
- Efavirenz (generic), lamivudine
(generic) and branded tenofovir.
- Efavirenz (generic) with
branded emtricitabine and tenofovir (Trudava).
A total of 119
people (44%) agreed to switch, 86 changing to efavirenz/lamivudine/tenofovir
and 29 to efavirenz/Truvada.
Wanting to remain
on a single-pill regimen was the main reason why people declined to switch (n
= 41). Also cited were concerns about travel and work (n = 15) and adherence (n
patients remained on their multi-agent regimen. However, a fifth switched
treatment because of central-nervous system (CNS) side-effects, most of these
individuals reverting to therapy with Atripla.
Only one patient cited pill burden as the reason for wanting to change therapy.
All the patients
who switched from Atripla maintained
virological control (below 40 copies/ml six and twelve months after treatment change).
annual saving achieved by people switching from branded Atripla to a generic-containing regimen was £159,500. Most of this saving
(£154,890.24) was associated with changing to efavirenz/lamivudine/tenofovir.
to generics was not without its challenges, including supply of medication and
patients receiving different brands. Greater than predicted use of generics led to delays in supply of stock. As a result, patients received different brands of medication when prescriptions were refilled. This meant that patients were receiving pills of differing appearance, increasing the potential for confusion about which pills had been taken.
Despite these concerns,
the investigators conclude that a regimen consisting of generic efavirenz and
lamivudine with tenofovir is a viable cost-saving and well-tolerated switch option.
Increased pill burden does not appear to be an issue for patients.