Pharmacoeconomic burden for delivery of anti-retroviral treatment: What are we in for?

Abstract

Background. Although the safety of transfused blood products has been continuously improving, even today, we still see transfusion transmitted viral infections. Objective: Our objective was to assess the pharmacoeconomic impact of antiretroviral therapy and highlight the occurrence of transfusion transmitted diseases [TTD]. Methods. Retrospective analysis of our Hemophilia A database. HIV1 and 2 were tested by ELISA followed by further testing with western Blot in retrovirus positive samples. Retrovirus viral load was monitored by quantitative PCR, and CD4 counts before and during treatment. CD4 counts were monitored by flow cytometry. Results. Amongst 93 Hemophilia A patient in our database since 1992, 17 (18.3%) had TTD. 13 (76.5%) patients had Anti-HCV positivity [6 HCV RNA PCR positive]; 2 (11.75%) were HIV-1 positive by western blot [both were retrovirus RNA PCR positive]; and 2 (11.75%) were HBV positive [both were also HBV DNA positive]. Two of these patients were positive for all the three viruses together. The two retrovirus RNA PCR positive cases, achieved a sustained virological remission [SVR] on the currently recommended HAART regimen following treatment over 27 and 32 months respectively. Furthermore, the CD4 counts have also normalized following SVR. Interestingly, we also observed an increased tendency for bleeding, especially when treatment was intensified by using boosted darunavir in one patient, which was controlled with prophylactic Factor VIII:C transfusions. The current cost of treatment [US dollars] for these two patients has been 16,120 and 15,172 over the past 12 months of treatment, respectively. Furthermore, the cost [US dollars] of prophylaxis with Factor VIII:C [15-25 units/kg, twice a week is 41,967 (annual) for the 2 patients. Summary and Conclusions. We report here SVR in two retroviral infections with RNA PCR negativity in both the treated patients. However, anti-retroviral treatment is ongoing according to the currently recommended international guidelines along with Factor VIII:C prophylaxis. Thus, the pharmacoeconomic burden with the average current cost of treatment for antiretroviral therapy and Factor VIII:C prophylaxis is about 36,630 USD, per patient in the long term.