LAUSR

Background: In February 2022 NHS England and Improvement changed the way it purchases Antiretrovirals (ARVs) to a national procurement agreement allowing equal access to ARVs across the country. Symtuza, Rezolsta, Evotaz and Eviplera no longer became routinely recommended and decisions to continue were to be through a Multi-disciplinary Team (MDT) meeting and Blueteq submission. This review aims to investigate the extent to which the implementation of Blueteq created the opportunity for prescribers to switch ARVs and the impact of this on cost savings. Method: Patients on Symtuza, Rezolsta, Evotaz and Eviplera were identified from the Trust's dispensing platform and upon clinical review, data was collated surrounding the switch and reasons for patients remaining on existing treatment. The data was then collated, cost of therapies added and then analysed to calculate cost savings. Results: 822 patients were identified as currently taking ARVs needing a Blueteq submission and as of the 1st December 2022, 677 patients reviewed, of which 39% have switched therapies. The most common reasons for remaining on existing treatment were patient preference, with a focus on Single Tablet Regimens (STRs) and adherence. 76% of patients continued on Symtuza and of those that switched only 7% switched to the individual components compared to 51% of those switching off Eviplera. 36% of patients who switched off Eviplera/Symtuza switched on to alternative STRs and 65% of patients switching off Rezolsta/Evotaz switched off Protease Inhibitors (PIs). Overall switches resulted in a saving in drug spending by almost £30,000 per month although 40% of patients taking either Eviplera, Evotaz or Rezolsta were switched to more expensive regimens. Conclusion: The Blueteq initiative has led to a proactive approach in initiating the review of patients taking boosted PIs. However Symtuza is the only STR containing a protease inhibitor, and as such patients needing a PI and STR have not switched treatment. Although savings have been made it should be noted that patient-focused treatment meant that often patients switched to more costly ARVs. Blueteqs have been used as an opportunity to discuss ARVs with patients and ensure they continue to take the medication that best suits their needs.