@article{fdi:010061740,
  title = {{F}ive-year trends in antiretroviral usage and drug costs in {HIV}-infected children in {T}hailand},
  author = {{C}ollins, {I}. and {C}airns, {J}. and {L}e {C}oeur, {S}ophie and {P}agdi, {K}. and {N}gampiyaskul, {C}. and {L}ayangool, {P}. and {B}orkird, {T}. and {N}a-{R}ajsima, {S}. and {W}anchaitanawong, {V}. and {J}ourdain, {G}onzague and {L}allemant, {M}arc},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {A}s antiretroviral treatment ({ART}) programs mature, data on drug utilization and costs are needed to assess durability of treatments and inform program planning. {M}ethods: {C}hildren initiating {ART} were followed up in an observational cohort in {T}hailand. {T}reatment histories from 1999 to 2009 were reviewed. {T}reatment changes were categorized as: drug substitution (within class), switch across drug class (non nucleoside reverse-transcriptase inhibitors ({NNRTI}) to/from protease inhibitor ({PI})), and to salvage therapy (dual {PI} or {PI} and {NNRTI}). {A}ntiretroviral drug costs were calculated in 6-month cycles ({US}$ 2009 prices). {P}redictors of high drug cost including characteristics at start of {ART} (baseline), initial regimen, treatment change, and duration on {ART} were assessed using mixed-effects regression models. {R}esults: {F}ive hundred seven children initiated {ART} with a median 54 (interquartile range, 36-72) months of follow-up. {F}ifty-two percent had a drug substitution, 21% switched across class, and 2% to salvage therapy. {W}hen allowing for drug substitution, 78% remained on their initial regimen. {M}ean drug cost increased from $251 to $428 per child per year in the first and fifth year of therapy, respectively. {PI}-based and salvage regimens accounted for 16% and 2% of treatments prescribed and 33% and 5% of total costs, respectively. {P}redictors of high cost include baseline age >= 8 years, non nevirapine-based initial regimen, switch across drug class, and to salvage regimen ({P} < 0.005). {C}onclusions: {A}t 5 years, 21% of children switched across drug class and 2% received salvage therapy. {T}he mean drug cost increased by 70%. {A}ccess to affordable second-and third-line drugs is essential for the sustainability of treatment programs.},
  keywords = {children ; {HIV} ; antiretroviral therapy ; cost ; {T}hailand ; {THAILANDE}},
  booktitle = {},
  journal = {{J}aids-{J}ournal of {A}cquired {I}mmune {D}eficiency {S}yndromes},
  volume = {64},
  numero = {1},
  pages = {95--102},
  ISSN = {1525-4135},
  year = {2013},
  DOI = {10.1097/{QAI}.0b013e318298a309},
  URL = {https://www.documentation.ird.fr/hor/fdi:010061740},
}