• Cost-Effectiveness of Open Formulary Access to Antiretrovirals: The Pennsylvania AIDS Drug Assistance Program Experience (Poster 285)
  Authored by Kauf, T.; Folby, J.; Tolson, J.; Pham, S.; Glaxo Wellcome Inc. Research Trial, North Carolina, USA

The AIDS Drug Assistance Program (ADAP) has been a major success in fostering access to antiretrovirals and other HIV-related medications in the U.S. ADAP is administered individually by all fifty states, with each state establishing criteria for enrollment (usually based on income level and, in some cases, the lack of adequate insurance coverage) and listing the medications available for payment. Some states have very limited formularies while others have essentially open formularies where any prescription for an individual with HIV/AIDS is covered. Some formularies rapidly add newly approved antiretrovirals while others do not or do so quite slowly.

So some people in some states have virtually unlimited access to what they need, while others in other states have severely limited access. The authors examined actual data from the Pennsylvania ADAP to evaluate the impact of an open formulary on disease progression and survival compared to a restricted formulary. They specifically looked at the impact of the addition of abacavir and efavirenz to the formulary comparing actual data from Pennsylvania before (November 1998) and after (May 1999) the addition of abacavir and efavirenz.

They utilized data from the Multicenter AIDS Cohort Study (MACS) as well as data from Glaxo Wellcome clinical trials with respect to disease progression/survival in response to antiretroviral regimens. They showed that the average drug cost with an open ADAP formulary was actually slightly lower than with a closed formulary. In addition survival was slightly higher with the open formulary. Cost effectiveness would also be improved with the open formulary.

The likely explanation is that the use of abacavir or efavirenz would foster better adherence to therapy due to the simplicity of regimens containing these agents. Better adherence should translate into an improved response, and improved antiviral response would mean improved survival and delayed disease progression. And, aside from the obvious benefits of delayed disease progression and improved survival, would come lower costs. Multiple prior studies have shown that each of these consequences is predictable. Everyone benefits from greater access to antiretrovirals, not just those infected with HIV but also the entire health care system because of reduced complications, hospitalizations and so forth. So, we need to attempt to keep ADAP formularies as open as possible and accessible for all that qualify.

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