OBJECTIVES

: Two generic combinations of commonly used anti-HIV drugs obtained their marketing authorization in 2017 (tenofovir disoproxil (TDF)/emtricitabine, abacavir/lamivudine). Their penetration is limited by the need to substitute fixed combinations of one tablet/day (like TDF/emtricitabine/rilpivirine (Eviplera^®) or abacavir/lamivudine/dolutégravir (Triumeq^®)) with several specialties in two tablets/day (TDF/emtricitabine+rilpivirine, abacavir/lamivudine+dolutegravir) as well as by a new tenofovir prodrug less nephrotoxic, tenofovir alafenamide (TAF). The first objective is to establish an inventory of the AP-HP consumptions in Eviplera^® and Triumeq^® (fixed associations that are growth-enhancing and most likely to be impacted), then to evaluate the population concerned and finally, to estimate the potential gains from the arrival of these generics.

METHODS

: Eviplera^® and Triumeq^® consumptions come from the SAP management software. The number of patients treated/year comes from the 2016/2017 data of dispensations to non-hospitalized patients. Earnings are calculated using Excel^® and are the sum of the difference between the most and least expensive strategy/month, the dispensation margin (22€/drug/month) and the profit-sharing scheme (a purchasing incentive allowing the hospital to earn 50% of the difference between the reimbursement tariff and the hospital price).

RESULTS

: In 2017, Triumeq^® and Eviplera^® are respectively at the 2nd and 5th place of anti-HIV drugs (8.2 and 6.2M€). Five hospitals represent 85% of consumptions. Eviplera^® treatment concerns 735 patients/month and 25,794 boxes/month. Triumeq^® treatment involves 626 patients/month and 21,695 boxes/month. A theoretical switch goal for 50% of patients would save respectively 0.8 and 0.7M€/year.

CONCLUSIONS

: The forecast savings for Eviplera^® are to be qualified by the rate of potential switch to a specialty containing TAF.

A 50% goal is an extreme scenario to focus on the five largest consumer hospitals but depends on the support of prescribers and patient adherence (choice patient-dependent). HIV patients with hospital prescriptions taking their treatment in community pharmacies also represent important financial stakes for the French Health Insurance.