# First-line antiretroviral therapy initiation for newly diagnosed people with HIV in the Netherlands: A retrospective analysis from 2016 to 2020

## TL;DR

This study examines how HIV treatment guidelines were followed in the Netherlands from 2016 to 2020, showing a shift from single-tablet to cheaper multi-tablet regimens.

## Contribution

The study provides real-world evidence of guideline adherence and cost changes with the adoption of generic multi-tablet regimens in HIV treatment.

## Key findings

- Compliance with DHHS guidelines increased from 82.8% in 2016 to 90.9% in 2020.
- Use of generic multi-tablet regimens rose from 17.8% in 2018 to 37.8% in 2020, reducing costs by 22.9%.
- Single-tablet regimen use decreased from 81.3% in 2016 to 60.3% in 2020.

## Abstract

HIV treating physicians in the Netherlands follow the guidelines of the Department of Health and Human Services (DHHS). Most of these recommended initial regimens are single-tablet regimens (STRs), which incur higher costs. By the end of 2017, generic NRTI backbones had become widely available, offering a potentially cheaper multi-tablet regimen. This study aimed to evaluate guideline compliance in people with HIV who started antiretroviral therapy (ART), the uptake of generic multi-tablet regimens (gMTRs), and associated medication costs.

This retrospective cohort study used data from the Dutch HIV Monitoring Foundation to determine the proportion of treatment-naïve people entering care who initiated ART according to the DHHS and type of ART regimens prescribed between January 2016 and December 2020. We analyzed ART prescriptions, both at the national level and per individual HIV treatment centers. We calculated the monthly ART costs based on Dutch medicine prices listed on www.medicijnkosten.nl for each calendar year.

In 2016, an integrase inhibitor-containing regimen was initiated in 77.3% which increased to 87.8% in 2020. The compliance rate to DHHS-recommended initial regimens ranged from 82.8% in 2016 to 90.9% in 2020. Most patients received single-tablet regimens, 81.3% in 2016 to 60.3% in 2020. After the introduction the gMTRs showed a steady increase from 17.8% in 2018 to 37.8% in 2020. The cost of the first-line regimen per patient decreased by 22.9% in 2020 compared with 2017. The decrease was larger in centers where treatment-naïve individuals with HIV were preferentially initiated on a gMTR.

There was a high compliance to the “DHHS-recommended initial regimens for most people with HIV” in the Netherlands. Most people who initiated ART received STRs, although the percentage of people who started on STRs gradually decreased over time. The use of gMTRs increased over time and was associated with lower medication costs.