416. An Evaluation of Patient Characteristics, Duration on Antiretrovirals (ARVs) and Adherence in a Large, Insured US Population Receiving HIV Treatment between 2010-2014
Session: Poster Abstract Session: HIV Clinical Practice Issues: Cost-Effectiveness, Long-Term Outcomes
Thursday, October 8, 2015
Room: Poster Hall

Background:

Current evaluations of ARV therapy adherence in real-world settings are important particularly in the context of quality of HIV care measurement.

Methods:

Claims were analyzed for insured patients in the Optum Research and Impact National Benchmark Databases. Adults aged ≥18 years with an HIV diagnosis, ARV receipt between 1/2010—12/2014 and 6 months of health plan enrollment pre-ARV initiation (baseline) were included; those with HIV-2 or who received only nucleos(t)ides (NRTIs) were excluded. Descriptive analyses were performed for patient characteristics, therapy duration and three adherence measures: Proportion of Days Covered (PDC) by any ARV (PDC1), PDC by 2 ARVs (PDC2) and Medication Possession Ratio (MPR). Adherence was observed from ARV initiation (index) through the earlier of either end of enrollment or 12/2014. Regimens included ARVs filled <14 days of index; treatment episodes included therapy with the same regimen until an ARV switch or a gap ≥90 days. To simplify analyses, calculations excluded boosting agents (BAs).

Results:

There were 25,320 patients included with 39,071 treatment episodes (Mean age=45.3 years; 84.4% male; 43.4% from the South; 35.2% ARV naïve). 19.2% had ≥1 baseline condition other than HIV/AIDS from the Quan-Charlson index. Except viral infections, lipid disorders (27.4%), respiratory infections (20.8%) and hypertension (19.5%) were most common using AHRQ classification (Figure 1). Excluding BAs and NRTIs, most common ARVs were efavirenz (included in 36.0% of treatment episodes), raltegravir (17.8%), atazanavir (15.4%), darunavir (13.4%) and lopinavir (8.7%). Mean post-index follow-up was 753.6 days, 30.7% of patients received >1 regimen in follow-up and the mean treatment episode duration was 489.6 days. Mean±SD adherence was 0.85±0.23 for PDC1, 0.82±0.23 for PDC2 and 0.88±0.18 for MPR; Figure 2 depicts the percent meeting various thresholds.

Conclusion:

Findings provide insights into variation in real world adherence for a large, insured HIV population. Given that claims-based adherence analyses reflect medication receipt but do not assess patient medication-taking behaviors, study findings warrant additional research further elucidating adherence and outcomes in HIV populations.

 

Jamie Forlenza, PharmD, MS1, Kimberley Brown, PharmD1, Adam Shprecher, PharmD1, Feng Cao, PhD2, Amy J Anderson, MS2, Neeta Tandon, PhD1 and Jianbin Mao, PhD2, (1)Janssen Scientific Affairs, LLC, Titusville, NJ, (2)Optum, Eden Prairie, MN

Disclosures:

J. Forlenza, Janssen Scientific Affairs, LLC: Employee , Salary
Johnson & Johnson: Shareholder , Stock

K. Brown, Janssen Scientific Affairs, LLC: Employee , Salary
Johnson & Johnson: Shareholder , Stock

A. Shprecher, Janssen Scientific Affairs, LLC: Employee , Salary
Johnson & Johnson: Shareholder , Stock

F. Cao, Optum that provides consulting service to Janssen and other pharmaceutical companies: Employee , Salary

A. J. Anderson, Optum that provides consulting service to Janssen and other pharmaceutical companies: Employee , Salary

N. Tandon, Janssen Scientific Affairs, LLC: Employee , Salary
Johnson & Johnson: Shareholder , Stock

J. Mao, Optum that provides consulting service to Janssen and other pharmaceutical companies: Employee , Salary

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.