In July 2016 NHSE circulated a letter regarding Commissioning for Value and antiretroviral drug switches. The letter noted that ‘These switches have been identified as not needing to recall patients to clinic or to introduce additional monitoring arrangements unless clinically indicated or the patient requires further support’. However the e-GFR decreases after starting cobicistat and checking at 4/52 is recommended.Methods
Patients suitable for antiretroviral drug switches were identified by pharmacy, a total of 50 patients (53% of our cohort). A review of the outcomes up to Jan 2017 was undertaken.Results
Eleven patients switched successfully from Kivexa to generic abavavir/lamivudine. Fifteen switched from Atripla to Truvada/efavirenz. Of these, four switched back due to side effects. In one case 4 months of drugs, costing £1384, were wasted. Two patients did not tolerate Rezolsta (AKI & diarrhoea). There were ten extra visits for safety bloods. The first prescription for the switches for all regimens was for two months to minimise waste. Additional staff time was required to generate the prescriptions, and the additional deliveries cost £1215 to date.Discussion
Switches from Atripla to Truvada/efavirenz and from PI/r to PI/cobicistat involved additional costs in terms of staff time, delivery charges and drug wastage. In December 2016, we decided to halt the switches to PI/cobicistat, as it was felt that the cost savings were insufficient to compensate for the additional workload, and also it might be a challenge to switch patients back to two drugs when generic darunavir and atazanavir become available.