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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e318298a309
Epidemiology and Prevention

Five-Year Trends in Antiretroviral Usage and Drug Costs in HIV-Infected Children in Thailand

Collins, Intira MSc*,†,‡,§; Cairns, John MPhil; Le Coeur, Sophie MD, PhD*,†,‡,¶; Pagdi, Karin MD#; Ngampiyaskul, Chaiwat MD**; Layangool, Prapaisri MD††; Borkird, Thitiporn MD‡‡; Na-Rajsima, Sathaporn MD§§; Wanchaitanawong, Vanichaya MD‖‖; Jourdain, Gonzague MD, PhD*,†,‡; Lallemant, Marc MD*,†,‡

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Abstract

Background: As antiretroviral treatment (ART) programs mature, data on drug utilization and costs are needed to assess durability of treatments and inform program planning.

Methods: Children initiating ART were followed up in an observational cohort in Thailand. Treatment histories from 1999 to 2009 were reviewed. Treatment changes were categorized as: drug substitution (within class), switch across drug class (non nucleoside reverse-transcriptase inhibitors (NNRTI) to/from protease inhibitor (PI)), and to salvage therapy (dual PI or PI and NNRTI). Antiretroviral drug costs were calculated in 6-month cycles (US$ 2009 prices). Predictors of high drug cost including characteristics at start of ART (baseline), initial regimen, treatment change, and duration on ART were assessed using mixed-effects regression models.

Results: Five hundred seven children initiated ART with a median 54 (interquartile range, 36–72) months of follow-up. Fifty-two percent had a drug substitution, 21% switched across class, and 2% to salvage therapy. When allowing for drug substitution, 78% remained on their initial regimen. Mean drug cost increased from $251 to $428 per child per year in the first and fifth year of therapy, respectively. PI-based and salvage regimens accounted for 16% and 2% of treatments prescribed and 33% and 5% of total costs, respectively. Predictors of high cost include baseline age ≥ 8 years, non nevirapine-based initial regimen, switch across drug class, and to salvage regimen (P < 0.005).

Conclusions: At 5 years, 21% of children switched across drug class and 2% received salvage therapy. The mean drug cost increased by 70%. Access to affordable second- and third-line drugs is essential for the sustainability of treatment programs.

© 2013 by Lippincott Williams & Wilkins

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