Using an automated decision support tool to improve HIV prescribing: A feasibility study

Area of Science:

• Infectious Diseases
• Pharmacoeconomics
• Health Informatics

Background:

• Antiretroviral therapy (ART) selection for people living with HIV (PLWH) is complex, influenced by individual factors and clinician judgment.
• The British HIV Association (BHIVA) promotes cost-effective prescribing and shared decision-making.
• Evaluating novel tools for optimizing ART regimens is crucial for patient care and resource management.

Purpose of the Study:

• To assess the acceptability and potential impact of a prototype automated decision support tool (DST) for ART prescribing.
• To improve the safety, individualization, and cost-effectiveness of ART regimens.
• To align prescribing practices with BHIVA guidelines and patient preferences.

Main Methods:

• A survey of PLWH and clinicians assessed treatment preferences and DST acceptability.
• A DST was developed to interpret electronic patient record data against 2022 BHIVA guidelines for ART switch options.
• The DST was applied to a cohort of patients receiving ART, with potential cost savings calculated.

Main Results:

• 86.7% of PLWH respondents were open to switching to more cost-effective ART.
• While most clinicians prioritized lower-cost treatments, awareness of ART costs was low (38%).
• Potential monthly cost savings of 28.4% (£26,630.25) were identified for eligible patients.

Conclusions:

• A DST utilizing BHIVA recommendations and routine data may be acceptable to patients and clinicians.
• The DST has the potential to achieve significant cost savings in ART prescribing.
• A considerable number of PLWH are willing to consider ART changes for cost-effectiveness.