Bictegravir+emtricitabine+tenofovir alafenamide and dolutegravir+rilpivirine for HIV, October 2021
Page last updated: 24 March 2022
Drug utilisation sub-committee (DUSC)
October 2021
Abstract
Purpose
To review the predicted versus actual utilisation of bictegravir+emtricitabine+tenofovir alafenamide (Biktarvy) and dolutegravir+rilpivirine (Juluca) in the first 24 months of R/PBS listing.
The report also presents the utilisation of Biktarvy and Juluca in the context of the utilisation of other Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS (R/PBS) listed medicines used in the management of Human Immunodeficiency Virus (HIV) and Pre-Exposure Prophylaxis (PrEP).
This report should be read in conjunction with the NPS MedicineWise report on HIV antiretroviral medicines 2021.
Date of listing on the Pharmaceutical Benefits Scheme (PBS)
Biktarvy was first R/PBS-listed for this indication on 1 March 2019. Juluca was first R/PBS-listed for this indication on 1 December 2018.
There are a variety of listings of drugs that are used to treat HIV. The first combination HIV therapy drug was listed on the R/PBS in the late 1990s. A complete list of HIV medications available on the R/PBS can be found in Attachment A.
Data Source / methodology
The analysis used data from Services Australia supplied prescriptions database.
Key Findings
- The xxxxxxxxxxx of Biktarvy was substantially xxxxxx than predicted. By year 2 of listing, the actual number of prescriptions dispensed was XXX percent xxxx than predicted.
- The utilisation of Juluca was significantly less than predicted. By year 2 of listing, the actual number of prescriptions dispensed was XX percent less than predicted.
- The listings of Biktarvy and Juluca were expected to realise savings to the R/PBS through substitution of existing listings. Since the listings of Biktarvy and Juluca, the overall expenditure on HIV R/PBS listings has fallen (Figure 5), however not as much as was predicted.
- Over the period 2013-2021
- Since 2013 the use of all single drug HIV prescriptions has fallen. Dolutegravir was the anomaly over this period, with use increasing in prevalent patients until the last quarter (Q4) of 2018, when its use also started falling. Despite dolutegravir’s prescription rate for initiating patients falling from 2014 levels, it was the highest single drug HIV medication prescribed until Q2 2019 when valganciclovir became slightly more popular.
- The picture with combination HIV drugs is less clear, however it is notable that since its listing in March 2019, Biktarvy has risen to be the leading combination medication prescribed for both initiating and prevalent patients. In 2020 Biktarvy was prescribed at just over double the rate of the next highest prescribed combination HIV medication, Dolutegravir + Abacavir + Lamivudine, which had been the leading combination HIV medication prescribed since 2017.
- The amount of patients initiating HIV medication has remained at a consistent level over time, while the number of prevalent patients showed a steady climb until Q1 2020 when the number of patients dropped, most likely because of the impact of the COVID-19 pandemic. By Q3 2020 the number of treated patients had almost returned to their pre-COVID level, however they were still slightly lower. The number of patients supplied a HIV listing has continued to fall slightly over Q4 2020 and Q1 2021.
- The number of patients initiating on PrEP has fallen slightly since the listing of tenofovir disoproxil + emtricitabine on the PBS. The number of prevalent patients on PrEP medication increased since listing, but fell between the first and second quarter of 2020, most likely due to the effect of social distancing in response to the COVID-19 pandemic in Australia. The number of prevalent patients supplied a PrEP listing has since returned to its pre-COVID level.
