Presentation Abstract

Session: 099-Antiretroviral Therapy of HIV-1 Infection
Sunday, Sep 18, 2011, 11:15 AM - 1:15 PM
Presentation Title: H2-791 - Association between Daily Antiretroviral Pill Burden and Hospitalization Risk in a Medicaid Population with HIV
Location: Exhibit Hall F1
Poster Board Number: 278
Presentation Number: H2-791
Pres. Time: Sunday, Sep 18, 2011, 11:15 AM - 1:15 PM
Category: H1
Keywords: ATRIPLA; Adherence; Hospitalization
Author(s): C. Cohen - Director of Research1, K. L. Davis - Senior Director, Health Economics 2, J. Meyers - Associate Director, Health Economics 2;
1Community Res. Initiative of New England, Boston, MA, 2RTI Hlth. Solutions, Research Triangle Park, NC.
Financial Disclosures:  C. Cohen,
Gilead Sciences, Inc. Role(s): Collaborator, Received: Consulting Fee.
K. L. Davis,
Gilead Sciences, Inc. Role(s): Research Contractor, Received: Consulting Fee.
J. Meyers,
Gilead Sciences, Inc. Role(s): Consultant, Received: Consulting Fee.
Abstract: Background: Previous studies show that antiretroviral therapy (ART) as a once daily single tablet regimen (STR) significantly improves patient adherence and virologic outcomes. We explored whether the adherence effect of STR also mediates better downstream outcomes, specifically hospitalization risk, vs. patients on two or more tablets per day (2+TPD). Methods: Medicaid claims from multiple states were retrospectively analyzed. Patients with an HIV diagnosis between 1/1/05 and 12/31/09 who received complete ART (2 NRTIs plus a third agent consisting of an NNRTI, protease inhibitor, CCR5 antagonist, integrase inhibitor) for ≥60 days in a once daily STR or in 2+TPD were selected. Hospitalizations and ART adherence based on refill timing (including selective non-adherence for those on 2+TPD) were observed from regimen initiation until discontinuation, switch (STR to 2+TPD or 2+TPD to STR), or database end. A multiple-event Cox model was estimated to assess hospitalization risk. Hospitalization rates were assessed with a Poisson model. The models included covariates for daily tablet burden (STR vs. 2+TPD), demographics, comorbidities, and prior ART experience. Results: 11,703 patients were included (2,563 STR, 9,140 2+TPD). Patients on STR were significantly more likely to reach all adherence thresholds measured (≥80% - ≥95%). STR patients had a 25% lower hospitalization risk compared with 2+TPD (hazard ratio=0.754; P<0.0001). The STR group had ~30% fewer hospitalizations vs. 2+TPD (incidence rate ratio=0.705; P<0.0001). For patients aged 35-44 years, male, and ART naive, the predicted number of hospitalizations per 100 patients was 46 and 65 for STR and 2+TPD, respectively. Conclusions: After controlling for prior ART experience and other confounders, once daily STR was associated with reduced hospitalization risk and resource use. For younger treatment experienced males, there were ~19 avoided hospitalizations per 100 STR patients vs. 2+TPD. Higher observed adherence in the STR group may explain these associations.

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