494. Evaluation of Healthcare Resource Use among HIV Patients in a Large Insured U.S. Population
Session: Poster Abstract Session: HIV Policy and Healthcare Utilization
Thursday, October 27, 2016
Room: Poster Hall

Background:  Assess all-cause (AC) & HIV-related healthcare resource use (HCRU) among HIV patients treated with the following antiretroviral (ARV) medications: darunavir/ritonavir (DRV/r), atazanavir/ritonavir (ATV/r), raltegravir (RAL), elvitegravir/cobicistat (EVG/c), efavirenz (EFV) in an insured U.S. population from 2010-2014.

Methods: Adult members of Optum Research & Impact National Benchmark Databases diagnosed with HIV-1, receipt of any of the above-listed ARVs in combination with emtricitabine (FTC)/tenofovir (TDF), & 6 months continuous enrollment pre-ARV initiation (baseline (BL)) were included.  A treatment episode (TxE) = a period of time on a specific ARV regimen. TxE start = first date a member had all ARVs specified in a regimen (i.e. DRV/r/FTC/TDF). TxE end = earliest date of: 1) discontinuation of all ARVs within a regimen for ≥ 90 days; 2) change of ARV regimen by dropping or adding ≥1 different ARV; 3) disenrollment from health plan; 4) death; or 5) study end date. Descriptive analyses were performed for the % of TxEs with ≥ 1 hospitalization, ER, office, or outpatient visit.  HCRU was measured from BL to end of TxE (EOT). 

Results:  25,350 members were included with 33,555 TxEs (DRV/r: 4800; ATV/r: 7997; RAL: 6018; EVG/c: 2299; EFV: 12,441).   Rates of AC HCRU by regimen are reported in Table 1.  Among the 33,555 TxEs, decreases in AC HCRU were observed for hospitalizations, outpatient, & office visits.  ER visits increased by 1.6% over time (Fig. 1).   Results varied by ARV, with the largest reductions noted for DRV/r, RAL, & ATV/r, respectively (Fig. 2).  Similar trends were observed for HIV-related HCRU (Fig. 3).

Table 1: All-Cause HCRU Rates by ARV Regimen (%)

 

DRV/r

ATV/r

RAL

EVG/c

EFV

 

BL

EOT

BL

EOT

BL

EOT

BL

EOT

BL

EOT

Hospitalization

9.2

4.7

5.8

4.1

8.6

4.9

7.5

6.6

7.5

8.0

ER

23.0

14.6

19.0

14.9

22.1

16.8

22.8

23.4

18.7

28.0

Office

86.8

69.8

83.7

66.6

90.8

75.4

91.6

84.4

87.4

86.2

Outpatient

53.4

40.3

53.2

42.2

53.2

41.9

47.0

48.3

46.9

58.0

Conclusion:  Therapy with DRV-, ATV- and RAL-containing regimens is associated with reductions in AC and HIV-related HCRU, whereas results varied for patients receiving EVG- and EFV-containing regimens.  Future research is warranted evaluating reasons for such variability.

 

Kimberly Woodruff, PharmD, PhD1, Jianbin Mao, PhD2, Kimberley Brown, PharmD1, Keith Dunn, PharmD1, Adam Shprecher, PharmD1 and Amy J Anderson, MS2, (1)Janssen Scientific Affairs, LLC, Titusville, NJ, (2)Optum, Eden Prairie, MN

Disclosures:

K. Woodruff, Janssen: Employee and Shareholder , Salary

J. Mao, Optum: Employee , Salary

K. Brown, Janssen: Employee and Shareholder , Salary

K. Dunn, Janssen Scientific Affairs, LLC: Employee and Shareholder , Salary

A. Shprecher, Janssen: Employee and Shareholder , Salary

A. J. Anderson, Optum: Employee , Salary

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