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A cost-savings analysis of a candidate universal antiretroviral regimen

Ripin, David; Prabhu, Vineet R.

Current Opinion in HIV and AIDS: July 2017 - Volume 12 - Issue 4 - p 403–407
doi: 10.1097/COH.0000000000000375
TOWARDS A UNIVERSAL ANTIRETROVIRAL REGIMEN: Edited by Charles W. Flexner, Willem D.F. Venter, and Polly Clayden

Purpose of review Despite significant strides in tackling HIV/AIDS in low-income and middle-income countries (LMICs), many treatment shortcomings remain, with limited drug selection to patients emerging as a critical challenge. The potential cost-savings benefits of adopting newer drugs as near-universal first-line antiretroviral (ARV) regimens that also provide improved clinical outcomes are discussed.

Recent findings In the near term, a fixed-dose combination of dolutegravir (DTG or D) with tenofovir disoproxil fumarate (TDF), and either lamivudine or emtricitabine (XTC), that is, tenofovir disoproxil fumarate/XTC/DTG (TXD) (X = XTC), could represent a near-universal first-line antiretroviral regimen offering significant clinical benefit, commodity savings, and overall health system savings. In the longer term, tenofovir alafenamide fumarate (TAF) could further reduce the cost of the first-line treatment backbone, with possible clinical benefits. Relative to the current generic standard of care in first-line, currently priced at ∼USD 90 per patient per year (pppy), high-volume production of TXD could lead to price reductions of ∼USD 20 pppy, whereas high-volume production of tenofovir alafenamide fumarate/XTC/DTG (TAFXD) could offer a reduction of ∼USD 40 pppy.

Summary With TXD in the near term, and TAFXD in the longer term, patients can benefit from better tolerated and more durable treatment, and programs will benefit by simplifying patient care and reducing cost to cover more patients.

Clinton Health Access Initiative, Boston, Massachusetts, USA

Correspondence to David Ripin, PhD, Clinton Health Access Initiative, 383 Dorchester Ave. Suite 400, Boston, MA 02127, USA. Tel: +1 860 908-0986; e-mail:

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