Adherence, healthcare resource use (HRU) and costs: A comparison of single-tablet regimen (STR) versus multi-tablet regimen (MTR) containing fixed dose combination (FDC) regimens

Objectives: A comparison of all available once-daily fixed dose STR to MTR (of any frequency, containing FDC) using randomized controlled trials, observational studies and economic models focused on adherence measures could inform HIV healthcare providers and policy makers regarding modalities of patient disease management to improve health outcomes. A systematic review and meta-analysis of published literature was conducted to compare STR to MTR. Methods: Published literature in English between 2005 and 2014 was searched using Embase, Medline, PubMed (Medline in-process) and ClinicalTrial.Gov databases. Two-level screening was undertaken by two independent researchers to finalize articles for evidence synthesis. Adherence, efficacy, safety, tolerability, HRU and costs were assessed comparing STR to MTR. A random effects meta-analysis was performed and heterogeneity examined using meta-regression. Adherence, HRU/Cost evaluations are summarized in this abstract. Results: Of the 39 articles identified for qualitative evidence synthesis, 22 reported patient adherence outcomes and 5 had quantifiable data for meta-analysis. STR patients were statistically significantly more adherent (per respective study-defined adherence goals) compared to MTR patients of any frequency (Odds Ratio (OR):2.37 (95% CI:1.68, 3.35) (p < 0.001)), twice-daily MTR (OR:2.53 (95% CI:1.13, 5.66) and once-daily MTR (OR:1.81 (1.15, 2.84)). Several studies reported significant reduction in HRU and costs among STR group versus MTR (albeit, none was eligible for meta-analysis): mean costs (annual, bi-annual, monthly or per-diem) were found to be lower for the STR group compared to MTR, and STR was also deemed cost-effective, based on its lower incremental cost-effectiveness ratio (ICER). Conclusions: STR demonstrated significant impact on improving adherence and potentially lowering overall HRU and costs in comparison to MTR. These findings may have policy implications for HIV disease management in resource-limited settings, considering the known associations between ART adherence and improvements in humanistic/clinical burden among HIV patients, and the potential HRU/ cost savings associated with STRs.