OBJECTIVES

Dolutegravir/lamivudine (DTG/3TC) is a two-drug regimen FDA-approved in 2019 and currently, the lowest priced single-tablet regimen (STR) based on wholesale acquisition costs. This study evaluates healthcare costs of DTG/3TC users compared to current standard of care three- or four-drug STRs.

METHODS

This retrospective study used IQVIA PharMetrics® Plus claims (1/1/2015–3/31/2020) from US adult patients with a diagnosis of HIV, ≥1 dispensing of DTG/3TC, ABC/DTG/3TC, BIC/FTC/TAF, EVG/COBI/FTC/TAF, or DRV/COBI/FTC/TAF on or after 04/08/2019 (approval of DTG/3TC for HIV; index date=first dispensing), and ≥6 months of continuous eligibility pre-index. All-cause and HIV-related healthcare costs were reported per-patient-per-month (PPPM) to account for varying lengths of follow-up. Adjusted cost ratios (aCR) were estimated using multivariate models adjusting for differences in baseline characteristics between cohorts. Analyses were further stratified by treatment-naïve and treatment-experienced.

RESULTS

A total of 22,061 patients met study criteria (590 DTG/3TC, 4,355 ABC/DTG/3TC, 9,068 BIC/FTC/TAF, 7,081 EVG/COBI/FTC/TAF, and 967 DRV/COBI/FTC/TAF). Mean age was similar across all cohorts (45.6–46.3 years) and mean follow-up period ranged 4.4–9.5 months. Mean all-cause total healthcare costs PPPM were significantly lower for DTG/3TC users compared to users of BIC/FTC/TAF ($3,368 vs. $3,783; aCR:0.77), EVG/COBI/FTC/TAF ($3,368 vs $3,456; aCR:0.70), and DRV/COBI/FTC/TAF ($3,368 vs. $4,029; aCR:0.78; all p<0.001), and similar to users of ABC/DTG/3TC ($3,368 vs. $3,322; aCR:0.97; p = 0.689). Across all comparisons, cost differences were primarily driven by significantly lower pharmacy costs (BIC/FTC/TAF: $2,595 vs. $3,116, aCR:0.76; EVG/COBI/FTC/TAF: $2,595 vs. $2,965, aCR:0.75; DRV/COBI/FTC/TAF: $2,595 vs. $3,558, aCR:0.69; ABC/DTG/3TC: $2,595 vs. $2,760, aCR:0.83; all p < 0.001). Similar trends were observed among the subgroups of treatment-naïve and treatment-experienced patients.

CONCLUSIONS

Patients treated with DTG/3TC had substantially lower (22–30%) healthcare costs compared to current standard of care STRs, although similar costs to ABC/DTG/3TC, highlighting the economic benefits of its use with sustained management of HIV infection.