OBJECTIVES: fixed dose combination like phosphazide/lamivudine (PhAZT/3TC) for the treatment of HIV infection are associated with improved medication adherence and better virologic suppression. The objective of this study was to estimate the budget impact to a Russian healthcare system of the use of new fixed dose combination twice-daily phosphazide/lamivudine versus fixed dose combination twice-daily zidovudine/lamivudine (ZDV/3TC) or once-daily abacavir/lamivudine (ABC/3TC) in adults with HIV.

METHODS: a cost-minimization and budget impact analysis comparing PhAZT/3TC, ZDV/3TC and ABC/3TC was conducted based on a review of current clinical evidence in treating HIV in Russia. Pharmacoeconomic assessment was calculated for 1-year period following standard methodology. We estimates direct healthcare costs associated with HIV management: drug cost, adverse event (anemia) inpatient and outpatient cost, pharmacogenetic screening to abacavir resistance. Costs for drugs and other health services were estimated from nationally published sources (exchange rate mean in 2018 - €1 = 71.8 RUB). One-way sensitivity analyses were performed to test model robustness.

RESULTS: PhAZT/3TC was less costly (68,716 RUB or €957) compared to ZDV/3TC (78,829 RUB or €1,098) and ABC/3TC (98,185 RUB or €1,367) for 1 person annual treatment. Annual budget for Russian 83 116 cohort (2018 year) of HIV patients was 7,088 mln RUB or €99 mln - 33% for ABC/3TC and 67% for ZDV/3TC. In budget impact analysis (BIA) usage of PhAZT/3TC will increase to 50% and usage of ABC/3TC and ZDV/3TC will decrease by half: to 16% and 34% respectively. The new budget will be 6,389 mln RUB or €89 mln, annual budget cost saving will be near €10 mlnCMA and BIA was mostly not sensitive to changes in drug costs.

CONCLUSIONS: the fixed dose combination of PhAZT/3TC was cost-saving versus fixed dose combination of ZDV/3TC and ABC/3TC.