PDF(Pubmed)
Abstract：
UNASSIGNED: There is a need to understand health care resource utilization (HCRU) and costs associated with treatment-experienced people with HIV (PWH) switching treatment regimens.
UNASSIGNED: To describe HCRU and cost during lines of antiretroviral therapy (ART) for treatment-experienced PWH switching to or restarting guideline-recommended, integrase strand transfer inhibitor (INSTI)-based multitablet regimens and single-tablet regimens.
UNASSIGNED: This retrospective claims study used data from Optum Research Database (January 1, 2010, to March 31, 2020) to identify lines of therapy (LOTs) for treatment-experienced adults who switched to or restarted INSTI-based regimens between January 1, 2018, and December 31, 2019. The first LOT during the study period was included in the analysis. We examined all-cause HCRU and costs and HIV-related HCRU and combined costs to the health plan and direct patient costs by site of service and compared between INSTI-based regimens: bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) (single tablet) vs dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) (single tablet), dolutegravir + emtricitabine/tenofovir alafenamide (DTG+FTC/TAF) (multitablet), and dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG+FTC/TDF) (multitablet). Analysis of HCRU by site of service was conducted following inverse probability treatment weighting. Multivariable regression was conducted using a generalized linear model with stepwise covariate selection to estimate HIV-related medical costs and control for remaining differences after inverse probability treatment weighting.
UNASSIGNED: 4,251 PWH were identified: B/F/TAF (n = 2,727; 64.2%), DTG/ABC/3TC (n = 898; 21.1%), DTG+FTC/TAF (n = 539; 12.7%), and DTG+FTC/TDF (n = 87; 2.1%). PWH treated with DTG+FTC/TAF had a significantly higher mean of all-cause ambulatory visits than PWH treated with B/F/TAF (1.8 vs 1.6, P < 0.001). A significantly smaller proportion of PWH treated with DTG/ABC/3TC had an all-cause ambulatory visit vs PWH treated with B/F/TAF (90.6% vs 93.9%, P < 0.001). All-cause total costs were not significantly different between regimens. Mean (SD) medical HIV-related costs per month during the LOT were not significantly different between B/F/TAF $699 (3,602), DTG/ABC/3TC $770 (3,469), DTG+FTC/TAF $817 (3,128), and DTG+FTC/TDF $3,570 (17,691). After further controlling for unbalanced measures, HIV-related medical costs during the LOT were higher (20%) but did not reach statistical significance for DTG/ABC/3TC (cost ratio = 1.20, 95% CI = 0.851-1.694; P = 0.299), 49% higher for DTG+FTC/TAF (cost ratio = 1.489, 95% CI = 1.018-2.179; P = 0.040), and almost 11 times greater for DTG+FTC/TDF (cost ratio = 10.759, 95% CI = 2.182-53.048; P = 0.004) compared with B/F/TAF.
UNASSIGNED: HIV-related medical costs during the LOT were lowest for PWH treated with INSTI-based single-tablet regimens. Simplifying treatment regimens may help PWH maintain lower health care costs.
UNASSIGNED: To describe HCRU and cost during lines of antiretroviral therapy (ART) for treatment-experienced PWH switching to or restarting guideline-recommended, integrase strand transfer inhibitor (INSTI)-based multitablet regimens and single-tablet regimens.
UNASSIGNED: This retrospective claims study used data from Optum Research Database (January 1, 2010, to March 31, 2020) to identify lines of therapy (LOTs) for treatment-experienced adults who switched to or restarted INSTI-based regimens between January 1, 2018, and December 31, 2019. The first LOT during the study period was included in the analysis. We examined all-cause HCRU and costs and HIV-related HCRU and combined costs to the health plan and direct patient costs by site of service and compared between INSTI-based regimens: bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) (single tablet) vs dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) (single tablet), dolutegravir + emtricitabine/tenofovir alafenamide (DTG+FTC/TAF) (multitablet), and dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG+FTC/TDF) (multitablet). Analysis of HCRU by site of service was conducted following inverse probability treatment weighting. Multivariable regression was conducted using a generalized linear model with stepwise covariate selection to estimate HIV-related medical costs and control for remaining differences after inverse probability treatment weighting.
UNASSIGNED: 4,251 PWH were identified: B/F/TAF (n = 2,727; 64.2%), DTG/ABC/3TC (n = 898; 21.1%), DTG+FTC/TAF (n = 539; 12.7%), and DTG+FTC/TDF (n = 87; 2.1%). PWH treated with DTG+FTC/TAF had a significantly higher mean of all-cause ambulatory visits than PWH treated with B/F/TAF (1.8 vs 1.6, P < 0.001). A significantly smaller proportion of PWH treated with DTG/ABC/3TC had an all-cause ambulatory visit vs PWH treated with B/F/TAF (90.6% vs 93.9%, P < 0.001). All-cause total costs were not significantly different between regimens. Mean (SD) medical HIV-related costs per month during the LOT were not significantly different between B/F/TAF $699 (3,602), DTG/ABC/3TC $770 (3,469), DTG+FTC/TAF $817 (3,128), and DTG+FTC/TDF $3,570 (17,691). After further controlling for unbalanced measures, HIV-related medical costs during the LOT were higher (20%) but did not reach statistical significance for DTG/ABC/3TC (cost ratio = 1.20, 95% CI = 0.851-1.694; P = 0.299), 49% higher for DTG+FTC/TAF (cost ratio = 1.489, 95% CI = 1.018-2.179; P = 0.040), and almost 11 times greater for DTG+FTC/TDF (cost ratio = 10.759, 95% CI = 2.182-53.048; P = 0.004) compared with B/F/TAF.
UNASSIGNED: HIV-related medical costs during the LOT were lowest for PWH treated with INSTI-based single-tablet regimens. Simplifying treatment regimens may help PWH maintain lower health care costs.
摘要：
■需要了解医疗保健资源利用（HCRU）和与有治疗经验的HIV患者（PWH）转换治疗方案相关的成本。
■为了描述抗逆转录病毒治疗（ART）期间的HCRU和费用-有经验的PWH切换或重新启动指南-推荐，整合酶链转移抑制剂（INSTI）为基础的多片方案和单片方案。
这项回顾性研究使用了OptumResearchDatabase（2010年1月1日至2020年3月31日）的数据，以确定有治疗经验的成年人的治疗路线（LOT），这些成年人在2018年1月1日至2019年12月31日期间改用或重新启动基于INSTI的方案。研究期间的第一个LOT包括在分析中。我们检查了全因HCRU和成本以及与HIV相关的HCRU，以及按服务地点划分的健康计划和直接患者成本的综合成本，并比较了基于INSTI的方案：比替格韦/恩曲他滨/替诺福韦艾拉酚胺（B/F/TAF）（单片）与dolutegravir/阿巴卡韦/拉米夫定（DTG/ABC/3TC）dolutegravir+恩曲他滨/替诺福韦alafenamide（DTG+FTC/TAF）（多片），和杜鲁特韦+恩曲他滨/富马酸替诺福韦酯（DTG+FTC/TDF）（多片）。按服务地点对HCRU的分析是在逆概率处理加权后进行的。使用具有逐步协变量选择的广义线性模型进行多变量回归，以估计与HIV相关的医疗费用并控制逆概率治疗加权后的剩余差异。
■确定了4,251PWH：B/F/TAF（n=2,727；64.2％），DTG/ABC/3TC（n=898；21.1%），DTG+FTC/TAF（n=539；12.7%），和DTG+FTC/TDF（n=87；2.1%）。DTG+FTC/TAF治疗的PWH的全因门诊就诊平均值明显高于B/F/TAF治疗的PWH(1.8vs1.6,P<0.001)。与使用B/F/TAF治疗的PWH相比，使用DTG/ABC/3TC治疗的PWH的比例明显较小（90.6％vs93.9％，P<0.001)。各方案之间的全因总成本没有显着差异。在LOT期间，每月平均（SD）与HIV相关的医疗费用在B/F/TAF$699（3,602）之间没有显着差异，DTG/ABC/3TC$770（3,469），DTG+FTC/TAF$817（3,128），和DTG+FTC/TDF$3,570（17,691）。在进一步控制不平衡措施后，在LOT期间与HIV相关的医疗费用较高（20％），但DTG/ABC/3TC没有统计学意义（费用比=1.20，95％CI=0.851-1.694；P=0.299），DTG+FTC/TAF高出49%(成本比=1.489，95%CI=1.018-2.179；P=0.040)，与B/F/TAF相比，DTG+FTC/TDF几乎高11倍（成本比=10.759，95%CI=2.182-53.048；P=0.004）。
■对于以INSTI为基础的单片治疗方案的PWH，LOT期间与HIV相关的医疗费用最低。简化治疗方案可能有助于PWH维持较低的医疗保健成本。
■为了描述抗逆转录病毒治疗（ART）期间的HCRU和费用-有经验的PWH切换或重新启动指南-推荐，整合酶链转移抑制剂（INSTI）为基础的多片方案和单片方案。
这项回顾性研究使用了OptumResearchDatabase（2010年1月1日至2020年3月31日）的数据，以确定有治疗经验的成年人的治疗路线（LOT），这些成年人在2018年1月1日至2019年12月31日期间改用或重新启动基于INSTI的方案。研究期间的第一个LOT包括在分析中。我们检查了全因HCRU和成本以及与HIV相关的HCRU，以及按服务地点划分的健康计划和直接患者成本的综合成本，并比较了基于INSTI的方案：比替格韦/恩曲他滨/替诺福韦艾拉酚胺（B/F/TAF）（单片）与dolutegravir/阿巴卡韦/拉米夫定（DTG/ABC/3TC）dolutegravir+恩曲他滨/替诺福韦alafenamide（DTG+FTC/TAF）（多片），和杜鲁特韦+恩曲他滨/富马酸替诺福韦酯（DTG+FTC/TDF）（多片）。按服务地点对HCRU的分析是在逆概率处理加权后进行的。使用具有逐步协变量选择的广义线性模型进行多变量回归，以估计与HIV相关的医疗费用并控制逆概率治疗加权后的剩余差异。
■确定了4,251PWH：B/F/TAF（n=2,727；64.2％），DTG/ABC/3TC（n=898；21.1%），DTG+FTC/TAF（n=539；12.7%），和DTG+FTC/TDF（n=87；2.1%）。DTG+FTC/TAF治疗的PWH的全因门诊就诊平均值明显高于B/F/TAF治疗的PWH(1.8vs1.6,P<0.001)。与使用B/F/TAF治疗的PWH相比，使用DTG/ABC/3TC治疗的PWH的比例明显较小（90.6％vs93.9％，P<0.001)。各方案之间的全因总成本没有显着差异。在LOT期间，每月平均（SD）与HIV相关的医疗费用在B/F/TAF$699（3,602）之间没有显着差异，DTG/ABC/3TC$770（3,469），DTG+FTC/TAF$817（3,128），和DTG+FTC/TDF$3,570（17,691）。在进一步控制不平衡措施后，在LOT期间与HIV相关的医疗费用较高（20％），但DTG/ABC/3TC没有统计学意义（费用比=1.20，95％CI=0.851-1.694；P=0.299），DTG+FTC/TAF高出49%(成本比=1.489，95%CI=1.018-2.179；P=0.040)，与B/F/TAF相比，DTG+FTC/TDF几乎高11倍（成本比=10.759，95%CI=2.182-53.048；P=0.004）。
■对于以INSTI为基础的单片治疗方案的PWH，LOT期间与HIV相关的医疗费用最低。简化治疗方案可能有助于PWH维持较低的医疗保健成本。
