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Generic antiretroviral drugs are a credible and cheaper alternative to brands

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f250 (Published 16 January 2013) Cite this as: BMJ 2013;346:f250

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Switching from branded to generic antiretroviral drugs for adults with HIV could save the US government nearly $1bn (£0.62bn; €0.75bn) in the first year alone, according to an economic modelling study. Using a mathematical simulation of HIV, the authors compared the costs and effectiveness of a single pill containing three branded agents (currently recommended)—a two pill option containing one generic and a three pill option containing two generic agents.

A single branded pill containing efavirenz, emtricitabine, and tenofovir was slightly more effective than three separate pills containing generic efavirenz, generic lamivudine, and branded tenofovir. However, the single branded pill was also substantially more expensive, costing an extra $114 800 for every quality adjusted life year gained. Switching to a less effective option would be controversial, say the authors, but could be considered if the savings were diverted to pay for other treatments, such as protease inhibitors for coinfection with hepatitis C. Generic regimens were associated with loss of roughly four months of life relative to the single branded pill in these analyses.

Generic efavirenz will soon be available in the US, alongside another 10 generics already on the market, says a linked editorial (doi:to come on Tuesday? p133). These agents have helped control HIV globally and offer large scale cost savings in the US at a time of political and financial upheaval in HIV care. Generic antiretroviral drugs are here to stay. We just need to work out how best to deploy them.

Notes

Cite this as: BMJ 2013;346:f250