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to Section One | to Arts & Entertainment
posted Friday, January 18, 2013 - Volume 41 Issue 3
Penny wise, pound foolish? - Generic HIV drugs cheaper but less effective, study says
Section One
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Penny wise, pound foolish? - Generic HIV drugs cheaper but less effective, study says

by Mike Andrew - SGN Staff Writer

Newly released clinical trial data suggest that generic HIV medications may be less effective than brand-name drugs, although they are substantially cheaper.

Researchers at Massachusetts General Hospital and Weill Cornell Medical College studied the potential effects of swapping the current single pill Atripla - which combines brand-name versions of tenofovir, emtricitabine, and efavirenz - for brand-name tenofovir plus generic forms of the other two drugs.

According to their article in Annals of Internal Medicine, the soon-to-be-available generic HIV drugs could save some $42,500 over the lifetime of a single patient, and might save the U.S. health-care system nearly $1 billion per year.

However, using generics could also result in 4.4 months of life lost per patient lifetime, researchers said.

AN ETHICAL QUANDARY
For doctors treating HIV with increasingly expensive medications while coping with limited government resources, the findings pose a real dilemma.

'The switch from branded to generic antiretrovirals would place us in the uncomfortable position of trading some losses of both quality and quantity of life for a large potential dollar savings,' lead researcher Dr. Rochelle Walensky told RTT Business News.

'This is a trade-off that many of us will find emotionally difficult, and perhaps even ethically impossible, to recommend.'

'Introducing generic medications would be one way for the health service to reduce expenditure, but this must not be at the expense of patient health,' Jason Warriner of the Terrence Higgins Trust, a British HIV-care group, told BBC reporters.

An increase in the use of cheaper generic HIV medications could see more patients with treatment failure, the study warned.

COMPLICATING TREATMENT
Clinical trial data suggest generic drugs might be slightly less effective than brand-name drugs, but the biggest problem is that they require patients to take three daily pills instead of one, increasing the risk some patients may miss doses.

'Anything that compromises the effectiveness of anti-HIV drugs, or makes people less likely to stick to treatments, would be a false economy,' Warriner warned.

'Currently, ensuring people with HIV are diagnosed and on treatment is a cornerstone of HIV prevention efforts. Effective medications not only keep those living with the virus fit and well, they also help to keep down new infections.'

In 2011 the cost of antiretroviral drugs in the U.S. was around $9 billion, most of which was paid for by government programs.

The currently recommended treatment for newly diagnosed patients is a single Atripla pill taken daily that combines antiretrovirals - tenofovir (Viread), emtricitabine (Emtriva), and efavirenz (Sustiva). A generic form of the antiretroviral drug lamivudine, which has a similar mechanism of action to emtricitabine, became available in January 2012, and a generic version of efavirenz is expected in the relatively near future.

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