1ISG-005 A cost-effective strategy: switching from one to two tablets, in a once-daily regimen in HIV patients

Background Following a request by the Central Management Organisation of our Health System (HS), a decision was made to change from a patented drug of three active principals, emtricitabine/tenofovir-disopropilo/rilpivirine (FTC/TDF/RPV) to two drugs, one patented (RPV) and one generic drug (FTC/TDF). Both were administered once-daily, providing the same therapeutic efficacy and treatment compliance but in a more cost-effective way. Purpose To describe the procedure to implement this strategy and patient’s acceptance of it. Material and methods After several meetings between the Pharmacy (PD) and the Infectious Diseases Department (IDD) it was decided to make the change at the following patient’s visit to the HS, either in the PD when the patient attended to pick up the medication or in the IDD in the patient’s scheduled consultations. Inclusion criteria: HIV patients treated with FTC/TDF/RPV up to June 2018 using e-prescribing records. Patients that did not contact our HS were excluded. A retrospective review from July to October 2018 was conducted. Patients that would not accept the PD’s change were referred to the IDD. Collected data were: age, gender, treatment after the change and acceptance. Results Out of 133 patients, seven were excluded. Mean age 47.6 years, 20% women. PD was responsible for 86% of the changes. Out of 126 patients included, 16 (13%) did not accept the change. Of these 16 patients, five ended up accepting it (three after visiting the IDD and two on their second visit to the PD) and 11 declined to switch therapy for the following reasons: swallowing problems (one) (actual treatment: elvitegravir/cobicistat/emtricitabine/tenofovir-alafenamide); adverse events (actual treatment: dolutegravir ±TDF/FTC (one); abacavir/lamivudine (two) or lamivudine (one); and six patients continued with FTC/TDF/RPV (four waiting for IDD next consultation and two due to medical decisions). Conclusion By the time this abstract was written, the change was made in 115/126 patients (91%). It is very important to highlight the efficient teamwork between the PD and the IDD in order to implement the new strategy in a short period of time. Although initially 13% disagreed, finally only 9% of patients did not accept the proposed change. On the other hand, this strategy has reduced the economic impact of HIV treatment in 51% of patients. References and/or acknowledgements Infectious Diseases Department. No conflict of interest.