Lamivudine reduces healthcare resource use when added to zidovudine-containing regimens in patients with HIV infection

Background: The impact on healthcare resource use of adding lamivudine to c oncurrent zidovudine-containing antiretroviral regimens was studied as a pa rt of a 52-week multinational study [CAESAR (Canada, Australia, Europe and South Africa)] in HIV-infected patients with moderate to severe immunodefic iency (25 to 250 CD4+ cells/mm(3)). Results: Significantly fewer lamivudine than placebo recipients required ho spitalisations (p = 0.002), unscheduled outpatient visits (p = 0.013) or pr escribed medications for HIV-related illness (p < 0.001). The mean number o f hospitalisations and the mean duration of hospitalisation for HIV-related illness were 47% and 51% lower, respectively, with lamivudine than with pl acebo. The mean number of unscheduled outpatient visits was 32% lower with lamivudine than with placebo. Lamivudine was also associated with a signifi cant reduction in the number of patients who were hospitalised (p = 0.04) o r required unscheduled outpatient visits (p = 0.02) as a result of adverse events. Conclusions: Notwithstanding the fact that retrospective studies have sugge sted that more effective antiretroviral treatments reduce healthcare use, t he CAESAR study is one of the few prospective controlled trials to demonstr ate that by slowing disease progression with combination therapy it is poss ible to reduce healthcare resource use in patients with HIV infection. Alth ough the combination of lamivudine and zidovudine alone is not likely to be sufficient to achieve complete long term suppression of viral replication and to halt disease progression, the study demonstrates the immediate econo mic benefits of preventing HIV progression in HIV-infected patients with mo derate to severe immunodeficiency (25 to 250 CD4+ cells/mm(3)). These findi ngs suggest that treatment regimens that slow progression of HIV infection have the potential to produce savings in non-drug healthcare costs, which m ay partly or fully offset the drug costs.