415. Use of Guideline-recommended Antiretroviral (ARV) Regimens in a Large US HIV Treatment-Naïve (TN) Population: Findings from a 5-year Analysis of Payer Claims Data
Session: Poster Abstract Session: HIV Clinical Practice Issues: Cost-Effectiveness, Long-Term Outcomes
Thursday, October 8, 2015
Room: Poster Hall

Background:

ARV therapy has greatly reduced HIV-related morbidity and mortality. The Department of Health and Human Services (DHHS) Panel has developed ARV Guidelines for Adults and Adolescents to provide practitioners with guidance based on knowledge of ARV drugs used to treat HIV in the US. The guidelines are periodically updated and made accessible as new evidence is available. This retrospective analysis explored real world use of ARV regimens listed in DHHS guidelines from 2010 to 2014 for a large insured US population with HIV.

Methods:

Adults with an HIV diagnosis and ARV claim between 2010 to 2014 in the Optum Research and Impact National Benchmark Database were included. Those with HIV-2 or prior ARV use were excluded. Baseline demographics, comorbidity burden (Quan-Charlson index) and annual treatment patterns, including receipt of DHHS guideline “Preferred/Recommended (P/R),” “Alternative (A)” or Non-P/R/A regimens, were described. In cases when a regimen's status changed in a given year, the highest recommendation was used for that year.

Results:

The analysis included 9,030 TN patients: mean age=41.7 years; 15.4% female; patients resided nationwide with 48.3% in the South and 27.3% in the Northeast; 20.8% of patients had ≥1 comorbidity other than HIV/AIDS. As seen in Figure 1, Preferred/Recommended (P/R) regimens were most common over the 5 years ranging between 47.1% and 81.8% of total regimens, while Alternative (A) regimens use ranged between 2.3% and 35.2%. Non-P/R/A regimens had a small decline year over year, from 20.6% in 2010 to 15.9% in 2014. The most common regimens used (≥5% of patients) were efavirenz, elvitegravir/cobicistat, rilpivirine, darunavir/ritonavir, raltegravir or atazanavir/ritonavir in combination with tenofovir diproxil fumarate/emtricitabine.   

 

Conclusion:

Real-world use of ARV regimens according the DHHS guidelines was adopted for the majority of this insured US HIV population. Despite the hierarchical assignment in the analysis that may have shifted regimens into P/R or A in a given year, there remained a cohort of patients who received DHHS guideline Non-P/R/A regimens each year. Further analyses are needed to better understand these treatment patterns, patient characteristics and outcomes.

Jamie Forlenza, PharmD, MS1, Kimberley Brown, PharmD1, Adam Shprecher, PharmD1, Feng Cao, PhD2, Amy J Anderson, MS2 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

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

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