Using cost as a consideration for antiretroviral regimen selection: an example using average wholesale prices

Area of Science:

• Health Economics
• Pharmacoeconomics
• Public Health Policy

Background:

• Funding for the AIDS Drug Assistance Program (ADAP) has not kept pace with the demand for antiretroviral therapy.
• This shortfall leads to waiting lists and reduced access to essential treatments and services.

Purpose of the Study:

• To demonstrate a cost-saving method for increasing patient treatment capacity within ADAP.
• To identify clinically equivalent, lower-cost antiretroviral drug regimens.

Main Methods:

• Calculated annual costs of preferred, alternative, and acceptable antiretroviral regimens using Average Wholesale Prices (AWPs).
• Determined the number of patients treatable per $1,000,000 by dividing regimen costs into this amount.

Main Results:

• Annual AWPs for preferred regimens ranged from $25,318 to $35,645.
• Alternative and acceptable regimens showed lower annual AWPs, ranging from $19,031 to $32,335.
• The number of patients treatable per $1,000,000 annually varied from 28 to 52, depending on the regimen's cost.

Conclusions:

• ADAP funding deficits risk patient care access through waiting lists.
• Cost-conscious selection of clinically equivalent, lower-cost drug regimens is a viable alternative approach.
• Development of clinical guidelines for exceptions to lower-cost regimens is necessary.