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Use of generic antiretroviral drugs could bring savings but lessen therapeutic effectiveness

Photo: iStockPhoto.comReplacing the combination of brand-name antiretroviral drugs currently recommended for control of HIV infection with soon-to-be-available generic medications could save the U.S. health care system almost

$1 billion a year, but may diminish the effectiveness of treatment, say Massachusetts General Hospital investigators. The team, reporting in the January 15 issue of Annals of Internal Medicine, examined the potential effect of such a change.

“The switch from branded to generic antiretrovirals would place us in the uncomfortable position of trading some losses of both quality and quantity of life for a large potential dollar savings,” says lead author Rochelle Walensky, an HMS professor of medicine and a member of the MGH Medical Practice Evaluation Center.

The currently recommended treatment for newly diag­nosed HIV patients is Atripla, a single pill taken daily that combines three brand-name antiretrovirals: Viread (tenofovir), Emtriva (emtricitabine), and Sustiva (efavirenz). A generic form of the antiretroviral drug lamivudine, which has a similar mechanism of action to emtri­citabine, became available in January 2012, and a generic version of efavirenz is expected soon.

Replacing two of the three branded drugs with generics could significantly reduce costs, say the authors, but would also have disadvantages. A more complicated treatment regimen, requiring three daily pills instead of one, increases the risk that some patients will miss doses, leading to the loss of antiretroviral effectiveness. Studies have also found that lamivudine may be slightly less effective and more vulnerable to the development of drug-resistant viral strains than emtricitabine.

The team’s findings indicate that switching all HIV-infected patients in the nation to the three-drug generic strategy would produce lifetime savings of $42,500 per eligible patient. In the first year alone, the nationwide savings would reach nearly $1 billion. However, the quality-adjusted loss of life expectancy could be as much as 4.5 months.