ArticleAnnals of internal medicine2013
Economic savings versus health losses: the cost-effectiveness of generic antiretroviral therapy in the United States.
Article in Annals of internal medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
60 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Estimating HIV Management and Comorbidity Costs Among Aging HIV Patients in the United States: A Systematic Review.Journal of managed care & specialty pharmacy · 2020Pooled it
- A meta-analysis comparing 48-week treatment outcomes of single and multi-tablet antiretroviral regimens for the treatment of people living with HIV.AIDS research and therapy · 2018Pooled it
- Guideline
- Guideline
- Meta-Analysis of Studies Comparing Single and Multi-Tablet Fixed Dose Combination HIV Treatment Regimens.Medicine · 2015Pooled it
- Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection: A meta-analysis of randomized controlled trials.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2014Pooled it
- Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs.Addiction (Abingdon, England) · 2015Trial
- The cost-effectiveness of improved hepatitis C virus therapies in HIV/hepatitis C virus coinfected patients.AIDS (London, England) · 2014Trial
- Trial
- The Cost-Effectiveness and Cost Savings of Gender-Affirming Mastectomy.Transgender health · 2026Article
- Article
- Projected Benefits of Long-Acting Antiretroviral Therapy in Nonsuppressed People With Human Immunodeficiency Virus Experiencing Adherence Barriers.Open forum infectious diseases · 2023Article
- Prevalence of Testing for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Among Medicaid Enrollees Treated With Medications for Opioid Use Disorder in 11 States, 2016-2019.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Economic impact of generic antiretrovirals in France for HIV patients' care: a simulation between 2019 and 2023.BMC health services research · 2022Article
- Past and future of HIV infection. A document based on expert opinion.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2022Review
- [Cost and factors associated with the prescription of non-antiretroviral drugs among HIV-infected patients under antiretroviral therapy in a reference hospital in Morocco].Medecine tropicale et sante internationale · 2022Article
- Cost-savings and potential cost-savings through the distribution of generic antiretroviral drugs within the statutory health insurance market of Germany between January 2017 and June 2019.BMC health services research · 2022Article
- Patient-reported outcomes among people living with HIV on single- versus multi-tablet regimens: Data from a real-life setting.PloS one · 2022Article
- Effectiveness and tolerability of dolutegravir and abacavir/lamivudine administered as two separate pills compared to their equivalent single-tablet regimen in a multicentre cohort in Spain.Journal of the International AIDS Society · 2021Article
- Cost-effectiveness and budget impact of dolutegravir/lamivudine for treatment of human immunodeficiency virus (HIV-1) infection in the United States.Journal of managed care & specialty pharmacy · 2021Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundU.S. HIV treatment guidelines recommend branded once-daily, 1-pill efavirenz-emtricitabine-tenofovir as first-line antiretroviral therapy (ART). With the anticipated approval of generic efavirenz in the United States, a once-daily, 3-pill alternative (generic efavirenz, generic lamivudine, and tenofovir) will decrease cost but may reduce adherence and virologic suppression.
objectiveTo assess the clinical effect, costs, and cost-effectiveness of a 3-pill, generic-based regimen compared with a branded, coformulated regimen and to project the potential national savings in the first year of a switch to generic-based ART.
designMathematical simulation of HIV disease.
settingUnited States. PATIENTS: HIV-infected persons.
interventionNo ART (for comparison); 3-pill, generic-based ART; and branded ART. MEASUREMENTS: Quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICERs) in dollars per quality-adjusted life-year (QALY).
resultsCompared with no ART, generic-based ART has an ICER of $21,100/QALY. Compared with generic-based ART, branded ART increases lifetime costs by $42,500 and per-person survival gains by 0.37 QALYs for an ICER of $114,800/QALY. Estimated first-year savings, if all eligible U.S. patients start or switch to generic-based ART, are $920 million. Most plausible assumptions about generic-based ART efficacy and costs lead to branded ART ICERs greater than $100,000/QALY. LIMITATION: The efficacy and price reduction associated with generic drugs are unknown, and estimates are intended to be conservative.
conclusionCompared with a slightly less effective generic-based regimen, the cost-effectiveness of first-line branded ART exceeds $100,000/QALY. Generic-based ART in the United States could yield substantial budgetary savings to HIV programs. PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.