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Generic antiretrovirals could save NHS £1.25 billion over 5 years, study finds
Michael Carter, 2014-11-04 18:10:00
patients taking antiretrovirals in the United Kingdom to generic versions of
the drugs they are taking, if available, would save around £1.25 billion
between 2015 and 2019, according to an analysis of UK treatment costs presented
on Tuesday at the International Congress on Drug Therapy in HIV Infection in
Glasgow by Andrew Hill of Liverpool University.
Almost all HIV
treatment and care in the UK is provided free of charge by the NHS. o There is increasing strain on these
services. The number of patients on HIV treatment has increased by 7%-10% for
several years and it is estimated that 100,000 people living with HIV will be
taking antiretroviral therapy by 2019. The number could be even higher if
efforts to find and treat the estimated 20%-25% of undiagnosed infections are
of antiretrovirals are equivalent to branded products and can be produced when
the patent on the original product expires after 20 years of market
exclusivity. The NHS has been encouraging the increased use of generic
equivalents wherever possible across a wide variety of health conditions in
order to reduce drug costs. The adoption of generic versions of lamivudine as a
cost-saving measure is already being implemented by the NHS in London.
The patents on
several antiretroviral drugs have already expired or will do so in the next few
years. This means generic formulations will become available.
available in generic versions are lamivudine, efavirenz, nevirapine and
zidovudine. In 2016 the patents on abacavir, lopinavir/ritonavir will expire,
and in 2017/18 tenofovir, darunavir/ritonavir and atazanavir/ritonavir will
also become available as generics.
antiretrovirals are typically 80% cheaper than the patented version. Therapy
with branded, co-formulated drugs currently costs the NHS between £4500-£7400
per patient per year. But the use of individual genetics could reduce the
annual per patient cost of triple therapy to £1000.
wanted to estimate the potential saving to the NHS over the next five years if
patients switched to generic versions of drugs once they became available.
assumed that the number of people taking HIV therapy in the UK would increase
by 8% each year from the current figure of 72,000 to 100,000 by 2019; that home
delivery – which saves the NHS VAT payment on drugs –would be used by 70% of
patients; that generics are 80% cheaper than patented prices; that patients
were switched to generics immediately the patents expired on branded drugs; and
that current patterns of antiretroviral drug use remained stable.
Use of patented,
co-formulated antiretrovirals would result in a total to the NHS of £2.41
billion between 2015-19. Switching to generics would reduce the bill to £1.16
billion, a potential saving of £1.25 billion.
Are there any
generics would mean that the average daily pill count for a patient would
increase from 2.3 pills to 3.5 pills.
But would this
affect patient outcomes? As part of the study, Andrew Hill and colleagues
conducted a meta-analysis of nine clinical trials comparing the efficacy of
co-formulated antiretrovirals versus individual agents. This analysis concluded
that switching to generic individual doses did not comprise virological
efficacy. All outcomes were within the 10% non-inferiority margin set by
findings were subject to a number of caveats. Potential savings would be even
higher if competition between manufacturers pushed down the cost of generics.
Conversely, reluctance by doctors and patients to use generic formulations
could mean that anticipated savings would be lower than anticipated.
Cooper of the Kirby Institute, University of New South Wales, Australia,
questioned whether a switch away from single-tablet regimens would be
beneficial for patients and public health goals in the long run.
trying to get people onto treatment the concept of one pill, once day is too
good to let go,” he said.
Andrew Hill said that
for the majority of patients tolerability and toxicity are the most desirable
features of a treatment regimen. “People would rather take three tablets of
well-tolerated medication,” he argued.
Dr Chris Wood of
the North Middlesex Hospital, London, also cautioned against the imposition of
generics on patients. “One pill a day allows many patients to normalize their
illness. Generics also cause confusion among patients if the product changes.”
investigators conclude that switching to generics could save the NHS £1.25
billion over the next five years. They say that the cost savings to the NHS could
be used to fund other much-needed HIV services, including prevention and
therapy for hepatitis C virus co-infection.