Minority of Those Who Switched to Costlier PrEP Had Clinical Reasons

Some patients who switched appear to have done so in anticipation of clinical indications.

A recent study conducted by investigators from the Harvard Pilgrim Health Care Institute has discovered that a minority of patients who switched to a more costly version of pre-exposure prophylaxis (PrEP) therapy had documented clinical reasons for doing so.

Results from the study were published in the journal Open Forum Infectious Diseases.

“One of the most critical barriers to broad and equitable PrEP use in the U.S. has been cost, including both perceived and actual costs,” Julia Marcus, lead author on the study said. “Generic TDF/FTC could revolutionize PrEP access, but that opportunity will be missed if resources are invested in a far more expensive medication without proportional improvements in clinical outcomes.”

There are currently 2 forms of PrEP therapy, co-formulated tenofovir disoproxil fumarate and emtricitabine (TDF/FTC, or Truvada) and the newer tenofovir alafenamide with emtricitabine (TAF/FTC, or Descovy).

Both forms are safe and highly effective, however, TAF/FTC costs significantly more per month.

For the study, the team of investigators analyzed data from electronic health records of 2,892 adults who were assigned male at birth, were prescribed TDF/FTC for PrEP in the year before FDA approval of TAF/FTC and had at least one PrEP prescription in the following year. 

They then evaluated how many of the PrEP users switched to the more costly version and whether they had a clinical indication for switching.

Findings from the study showed that 11.9% of the participants switched to TAF/FTC the first year it was available. However, the investigators found that only 7% of the participants who switched had clinical indications to do so.

Additionally, when indications for switching also included risk factors for developing renal dysfunction, such as hypertension and diabetes, up to 27% of switching was clinically indicated.

“Efforts to end the HIV epidemic may be threatened if more expensive medicines are used when comparably effective, cheaper options are available,” Kenneth Mayer, co-author on the study said. “Our study highlights the need to ensure that decisions about PrEP medications are both clinically sound and cost-effective.”