As antiretroviral treatment (ART) programs mature, data on drug utilization and costs are needed to assess durability of treatments and inform program planning.
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.
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).
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.
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*Program for HIV Prevention and Treatment, Institut de Recherche pour le Développement (IRD) UMI 174-PHPT, France;
†Faculty of Associated Medical Sciences, Chiang Mai University, Thailand;
‡Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA;
§Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom;
‖Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom;
¶Centre Population et Développement, UMR 196 CEPED, Université Paris Descartes INED-TRD, Paris, France;
#Lamphun Provincial Hospital, Lamphun, Thailand;
**Prapokklao Hospital, Chantanaburi, Thailand;
††Bhumibol Adulyadej Hospital, Bangkok, Thailand;
‡‡Hat Yai Hospital, Hat Yai, Thailand;
§§Mahasarakham Hospital, Mahasarakham, Thailand; and
‖‖Chiang Kham Hospital, Chiang Kham Thailand.
Correspondence to: Intira Collins, MSc, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (e-mail: email@example.com).
Presented at Fourth International Workshop on HIV Pediatrics, July 20–21, 2012, Washington, DC.
Supported by The Global Fund to fight AIDS, Tuberculosis and Malaria (Thailand Grant Round 1 sub recipient PR-A-N-008); Institut de Recherche pour le Développement (IRD), France; International Maternal Pediatric Adolescents Aids Clinical Trials Group (IMPAACT); The National Institutes of Health, US (R01 HD 33326; R01 HD 39615); Ministry of Public Health, Thailand; Oxfam Great Britain, Thailand; and United Kingdom Medical Research Council Doctoral Training Account Studentship for Intira Collins.
The authors have no conflicts of interest to disclose.
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Received November 16, 2012
Accepted March 29, 2013