# Optimising antiretroviral therapy through a proactive treatment algorithm: a cost-effective strategy in Dutch healthcare for people with HIV

## TL;DR

A proactive treatment algorithm for HIV patients in the Netherlands significantly reduced antiretroviral therapy costs while maintaining effective care.

## Contribution

A cost-effective ART algorithm was developed and implemented to proactively switch HIV patients to cheaper treatment regimens.

## Key findings

- 81.1% of switch proposals were accepted by prescribers and 84.9% by patients.
- Annual ART costs per eligible individual dropped from €10,923 to €8,580, saving €2 million annually.
- DOR/TDF/3TC was the most prescribed regimen after the switch.

## Abstract

A wide range of effective antiretroviral therapy (ART) regimens with favourable side effects are available. More than 70% of HIV care costs in the Netherlands are attributed to ART. We developed an ART algorithm to proactively switch virologically suppressed individuals to a more cost-effective HIV treatment.

This prospective study implemented our ART algorithm in two large Dutch HIV clinics, where a pharmacist screened ART regimens for 1 year. Individuals were considered suitable for a switch if their current ART exceeded €600 per month, considering renal function and/or tubular toxicity, hepatitis B status, and resistance history. If eligible, advice with a switch proposal was recorded in the patient file. The objective was to investigate the acceptance of the proposal and the effect of proactive switching on the total costs of ARTs.

Of 1596 people living with HIV, 840 (52.6%) were eligible. Prescribers accepted 81.1% of the switch proposals, and 84.9% of eligible individuals agreed to the proposed switch. Ultimately, 558 individuals accepted the new ART regimen proposal, with doravirine/tenofovir disoproxil fumarate/lamuvidine (DOR/TDF/3TC) being the most prescribed (61.6%). The switch led to significant cost savings, reducing annual ART expenditure from €10 923 to €8580 per eligible individual, totalling almost €2 million (−21.4%) in savings annually.

Our ART algorithm demonstrated high acceptance by prescribers and people with HIV, leading to substantial cost savings. The algorithm can be easily implemented in other HIV clinics to offer even more significant cost savings to Dutch healthcare payers.