%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Collins, I.
%A Cairns, J.
%A Le Coeur, Sophie
%A Pagdi, K.
%A Ngampiyaskul, C.
%A Layangool, P.
%A Borkird, T.
%A Na-Rajsima, S.
%A Wanchaitanawong, V.
%A Jourdain, Gonzague
%A Lallemant, Marc
%T Five-year trends in antiretroviral usage and drug costs in HIV-infected children in Thailand
%D 2013
%L fdi:010061740
%G ENG
%J Jaids-Journal of Acquired Immune Deficiency Syndromes
%@ 1525-4135
%K children ; HIV ; antiretroviral therapy ; cost ; Thailand
%K THAILANDE
%M ISI:000330451600017
%N 1
%P 95-102
%R 10.1097/QAI.0b013e318298a309
%U https://www.documentation.ird.fr/hor/fdi:010061740
%> https://www.documentation.ird.fr/intranet/publi/2014/03/010061740.pdf
%V 64
%W Horizon (IRD)
%X Background: As antiretroviral treatment (ART) programs mature, data on drug utilization and costs are needed to assess durability of treatments and inform program planning. Methods: Children initiating ART were followed up in an observational cohort in Thailand. Treatment histories from 1999 to 2009 were reviewed. Treatment 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). Antiretroviral drug costs were calculated in 6-month cycles (US$ 2009 prices). Predictors 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. Results: Five hundred seven children initiated ART with a median 54 (interquartile range, 36-72) months of follow-up. Fifty-two percent had a drug substitution, 21% switched across class, and 2% to salvage therapy. When allowing for drug substitution, 78% remained on their initial regimen. Mean 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. Predictors of high cost include baseline age >= 8 years, non nevirapine-based initial regimen, switch across drug class, and to salvage regimen (P < 0.005). Conclusions: At 5 years, 21% of children switched across drug class and 2% received salvage therapy. The mean drug cost increased by 70%. Access to affordable second-and third-line drugs is essential for the sustainability of treatment programs.
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