IMPACT OF PROTEASE INHIBITORS ON DRUG USE AND COST FOR HOSPITAL PATIENTS WITH HIV
Florence Peyron, SaÏd Rahmouni, Angelise Flori, Jacques Moreau,
Jean-Jacques Charbit, Martine Buès-Charbit, and Guy Balansard

OBJECTIVE: To evaluate the impact of protease inhibitors on drug cost and frequency of admission-defining events for HIV-infected patients in the infectious diseases unit of F Houphouët Boigny Hospital in Marseilles, France, which provides conventional hospitalization and outpatient care.

METHODS: Data from a prospective eight-year study conducted from January 1, 1990, to December 31, 1997, were used. Data from nurse records were collected daily by a pharmacy resident. Statistical analyses were performed to compare 1997 data with previous years, since protease inhibitors were not available in France until March 1996.

RESULTS: A total of 1,558 inpatients, accounting for 2,717 admissions, participated in the study. From 1995 to 1997, we observed a decrease in the percentage of hospitalized patients compared with the total number of patients (48.8%). We also noticed a reduction in number of stays (52%) and mean duration of stays (from 16.06 ± 1.81 to 11.08 ± 1.80 d). Total drug cost in the inpatient care unit dropped by one-half (based on 100 patients / y). The number of hospital admissions and mean drug cost per stay also decreased for some opportunistic infections described as late complications of AIDS; at the same time, drug costs in the outpatient unit rose sharply.

CONCLUSIONS: This study confirms recent advances in HIV management. Use of protease inhibitors has reduced the relative risk of opportunistic infections and cost of inpatient treatment. This reduction has been associated with a sharp cost increase for outpatient therapy, resulting from widespread use of protease inhibitors.

J Pharm Technol 1999;15:212-8.