L Lacey1, M J Gill. 1. Glaxo Wellcome, Greenford, Middlesex, England.
Abstract
BACKGROUND: The impact on healthcare resource use of adding lamivudine to concurrent zidovudine-containing antiretroviral regimens was studied as a part of a 52-week multinational study [CAESAR (Canada, Australia, Europe and South Africa)] in HIV-infected patients with moderate to severe immunodeficiency (25 to 250 CD4+ cells/mm3). RESULTS: Significantly fewer lamivudine than placebo recipients required hospitalisations (p = 0.002), unscheduled outpatient visits (p = 0.013) or prescribed medications for HIV-related illness (p < 0.001). The mean number of hospitalisations and the mean duration of hospitalisation for HIV-related illness were 47% and 51% lower, respectively, with lamivudine than with placebo. The mean number of unscheduled outpatient visits was 32% lower with lamivudine than with placebo. Lamivudine was also associated with a significant reduction in the number of patients who were hospitalised (p = 0.04) or required unscheduled outpatient visits (p = 0.02) as a result of adverse events. CONCLUSIONS: Notwithstanding the fact that retrospective studies have suggested that more effective antiretroviral treatments reduce healthcare use, the CAESAR study is one of the few prospective controlled trials to demonstrate that by slowing disease progression with combination therapy it is possible to reduce healthcare resource use in patients with HIV infection. Although the combination of lamivudine and zidovudine alone is not likely to be sufficient to achieve complete long term suppression of viral replication and to halt disease progression, the study demonstrates the immediate economic benefits of preventing HIV progression in HIV-infected patients with moderate to severe immunodeficiency (25 to 250 CD4+ cells/mm3). These findings suggest that treatment regimens that slow progression of HIV infection have the potential to produce savings in non-drug healthcare costs, which may partly or fully offset the drug costs.
RCT Entities:
BACKGROUND: The impact on healthcare resource use of adding lamivudine to concurrent zidovudine-containing antiretroviral regimens was studied as a part of a 52-week multinational study [CAESAR (Canada, Australia, Europe and South Africa)] in HIV-infectedpatients with moderate to severe immunodeficiency (25 to 250 CD4+ cells/mm3). RESULTS: Significantly fewer lamivudine than placebo recipients required hospitalisations (p = 0.002), unscheduled outpatient visits (p = 0.013) or prescribed medications for HIV-related illness (p < 0.001). The mean number of hospitalisations and the mean duration of hospitalisation for HIV-related illness were 47% and 51% lower, respectively, with lamivudine than with placebo. The mean number of unscheduled outpatient visits was 32% lower with lamivudine than with placebo. Lamivudine was also associated with a significant reduction in the number of patients who were hospitalised (p = 0.04) or required unscheduled outpatient visits (p = 0.02) as a result of adverse events. CONCLUSIONS: Notwithstanding the fact that retrospective studies have suggested that more effective antiretroviral treatments reduce healthcare use, the CAESAR study is one of the few prospective controlled trials to demonstrate that by slowing disease progression with combination therapy it is possible to reduce healthcare resource use in patients with HIV infection. Although the combination of lamivudine and zidovudine alone is not likely to be sufficient to achieve complete long term suppression of viral replication and to halt disease progression, the study demonstrates the immediate economic benefits of preventing HIV progression in HIV-infectedpatients with moderate to severe immunodeficiency (25 to 250 CD4+ cells/mm3). These findings suggest that treatment regimens that slow progression of HIV infection have the potential to produce savings in non-drug healthcare costs, which may partly or fully offset the drug costs.
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