De-simplification for cost savings

321 HIV-infected Canadian patients on Triumeq® were offered to voluntarily switch to Tivicay® in combination with generic abacavir/lamivudine from January 2015 to January 2018. No incentives were provided. The objective of the study was to investigate de-simplification as a cost-saving strategy. During the same period, patients who started therapy were given the same options of receiving the single tablet regimen (STR) or generic co-formulation. Of the 321 patients already on therapy with Triumeq® 177 (55 %) accepted to switch to the generic co-formulation and of patients initiating therapy, 63% choose the combination of Tivicay® and generic abacavir/lamivudine. There was no increase in resistance development, viral break-
throughs or adverse events in the switch group compared to those who continued STR. The cost saving during the first year was Cdn $ 1 319 686.

Ref; Krentz et al. HIV Med. 2019 Mar;20(3):214-221. doi: 10.1111/hiv.12701. Epub 2019 Jan 11.

Comment: The cost savings of switching to combinations with generic drugs may be substantial. In the present study a majority of the patients voluntarily choose to de-simplify treatment by taking two tablets a day instead of one without any personal economic gain but rather for altruistic reasons. To my knowledge it has not been shown in clinical studies that the outcome has been better with one tablet compared to two tablets once a day. It seems very reasonable to de-simplify when possible to reduce costs.