15 January 2013

New HIV drugs save more money but less effective

The first generic versions of some key HIV drugs will soon reach the US market, and according to a new study, their use could save nearly $1 billion a year.


The first generic versions of some key HIV drugs will soon reach the US market, and according to a new study, their use could save nearly $1 billion a year, although they may be less effective than more expensive brand-name options.

The report, published in the latest edition of the Annals of Internal Medicine, found that in 2011, US spending on antiretroviral drugs totaled around $9 billion, mostly paid for by government sources.

"The programmes that pay for these drugs are looking to save costs," said Bruce Schackman, chief of the division of health policy at Weill Cornell Medical College and an author of the study.

Current treatments

A currently recommended treatment for newly diagnosed HIV patients is Atripla, a single daily pill sold by Gilead Inc that combines three brand-name antiretrovirals: Viread, known generically as tenofovir; Emtriva, or emtricitabine; and Sustiva, or efavirenz.

A generic version of lamivudine, which has a similar mechanism of action to emtricitabine, became available this month, while a generic version of efavirenz is expected in the relatively near future.

Gilead, which recently started selling a four-drug HIV pill, has dominated the market with its combination pills, which make it easier for patients to adhere to treatment regimens.

"For some patients, switching from taking one pill once a day to two or three pills once a day won't make a difference. For others it will be the straw that breaks the camel's back," Schackman said.

What the study showed

The paper also noted that laboratory studies have found that lamivudine may be slightly less effective and more vulnerable to the development of drug-resistant viral strains than emtricitabine.

The study showed that switching all HIV-infected patients in the United States to the three-drug generic strategy would produce lifetime savings of $42 500 per 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 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," said Dr Rochelle Walensky of Massachusetts General Hospital medical practice evaluation center, the study's lead author.

She suggested that clinicians and patients might be more amenable to generic drug regimens if they were assured that the savings would be redirected back to AIDS programmes, reduced co-payment fees or coverage of treatment for other viral diseases such as hepatitis C infection.

(Reuters Health, January 2013)

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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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