Cost of noninfectious comorbidities in patients with HIV

Guaraldi, Giovanni; Zona, Stefano; Menozzi, Marianna; Carli, Federica; Bagni, P; Berti, Alessandra Paim; Rossi, Elisa; Orlando, Gabriella; Zoboli, G.; Palella, Frank J.

doi:10.2147/ceor.s40607

Cited by 47 publications

(56 citation statements)

References 39 publications

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“…The increase of life expectancy of HIV + patients in the last decades due to efficacy of ART has determined patients’ aging with consequent increase of comorbidities and related health expenditure [9, 22]. HIV care involves taking ART and having regular check-ups by healthcare providers with opportunity for early diagnosis of comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Treating with ART has resulted in a continuous increase of the total treatment cost, mainly because of the appearance of new, more effective but more expensive drugs during last years [5, 6]. The increase in life expectancy of HIV-infected patients [7, 8] has also driven increased costs due to life-long HIV treatment and concurrent age-related comorbidities [9]. …”

Section: Introductionmentioning

confidence: 99%

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The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

Quiros-Roldan

Magoni²,

Raffetti

et al. 2016

BMC Public Health

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BackgroundThe increase in life expectancy of HIV-infected patients has driven increased costs due to life-long HIV treatment and concurrent age-related comorbidities. This population-based study aimed to investigate the burden of chronic diseases and health costs for HIV+ subjects compared to the general population living in Brescia Local health Agency (LHA) over a 12-year period.MethodsLHA database recorded diagnoses, deaths, drug prescriptions and health resource utilization for all residents during 2003–2014. We estimated HIV prevalence and incidence, HIV-related mortality as well as prevalence of chronic diseases in HIV+ subjects. Observed/expected ratio of chronic diseases was calculated by indirect standardization with the general population as reference. Direct cost of HIV care and determinants were estimates across the period.ResultsHIV prevalence increased from 220 to 307 per 100 000 person-years while incidence decreased from 16.1 to 10.8 per 100 000 person-years from 2003 to 2014. Prevalence of most comorbidities increased over time but it reduced significantly (annual mean change − 0.7 %) when adjusting for age and gender. Observed to expected ratio for each chronic disease in HIV+ subjects decreased over time. Cost of HIV+ cures increased (+25 %) mainly due to cost for drugs (+50 %) but it stabilized in recent years. CD4+ cell count at the time of diagnosis was an important predictor of cost for HIV management.ConclusionsExpenditures for HIV-infection are driven mainly by drugs cost and they have increased overtime. However, our findings suggest that spending on public health for HIV care can improve prognosis of HIV-infected patients, reduce transmission of HIV infection and reduce the global burden of chronic diseases, leading to a reduction of HIV global cost in the medium-long time.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3804-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

Quiros-Roldan

Magoni²,

Raffetti

et al. 2016

BMC Public Health

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“…However -due to the chronicity of the disease, and in particular because of a significant increase in lifespan -the prevalence of Non-AIDS Related Morbidities (NARMs) has increased in HIV-infected individuals. Compared to the general population, HIV infection is associated with a higher [2] risk of developing cardiovascular disease, kidney disease, osteopenia/osteoporosis, diabetes and neuropsychiatric disorders, and to the risk of developing these earlier than seen in the general population [3]. It should also be emphasized that the high impact of the cost of ART itself [4], the risk of developing resistance and the switch between treatments -possibly required by the occurrence of adverse events or by a therapeutic failure -all contribute to exacerbate the burden of the disease for the National Health Service.…”

Section: Methodsmentioning

confidence: 99%

A cost-effectiveness analysis of E/C/F/TAF vs three boosted regimens in the Italian context

Pradelli¹,

Perri

Rizzardini

et al. 2017

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BACKGROUND: Highly Active Antiretroviral Therapy (HAART) has transformed HIV into a lifelong condition. Following the chronicity of the disease, and significant increase in lifespan -the prevalence of comorbidities increased in HIV+ subjects that are exposed both to a higher risk of developing cardiovascular disease, renal disease, osteopenia/osteoporosis and diabetes, and to the risk of developing them early. Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate (E/C/F/TAF), a complete, Single-Tablet antiretroviral Regimen (STR) that combines the effectiveness and tolerability of integrase inhibitors with an innovative backbone was recently introduced in Italy. Compared to Tenofovir Disoproxil Fumarate (TDF), TAF reaches the sites of action more efficiently, reducing tenofovir plasma concentration to more than 90% and the risk of off-target effects. OBJECTIVE: A patient-level micro-simulation model was adapted to the Italian context to evaluate E/C/F/TAF costeffectiveness vs three boosted regimens for HIV+ patients treatment. METHODS: A Markov micro-simulation model was adapted to the Italian context for the evaluation of the cost-effectiveness in patients with HIV. The total cost per patient accounts for drug therapies and the management of adverse events and comorbidities. The quality-adjusted life expectancy (in QALYs) is calculated by weighing the years of life lived by the utility weights. A 70-year time horizon was adopted to simulate a lifetime analysis; shorter time horizons were considered in the sensitivity analyses. 3.5% discount rate was applied both for costs and future benefits. The rate of virologic suppression at 48 weeks with E/C/F/TAF is 92.3%; for the other treatments such proportion is calculated by applying to the reference rate the relative risks, as calculated in a recent network meta-analysis (NMA). Alternative treatments considered in this analysis are three boosted regimens commonly used in Italy: tenofovir disoproxil fumarate/emtricitabine/elvitegravir/ cobicistat in STR; tenofovir disoproxil fumarate/emtricitabine + darunavir/ritonavir; tenofovir disoproxil fumarate/emtricitabine + atazanavir/ritonavir. RESULTS: E/C/F/TAF improves survival and quality of life (20.17 LY and 14.89 QALY), with the lowest total cost (€ 280,528), thus resulting dominant over three comparators considered as starting therapy. The sensitivity analysis confirms the results of the base case: at a willingness-to-pay threshold of € 30,000 per QALY, the E/C/F/TAF strategy is the most cost-effective, with a 90% probability and it is the most cost-effective even with a threshold of € 10,000 per QALY, with a 50% probability. CONCLUSION: E/C/F/TAF can be a sustainable alternative to currently available treatments, combining the advantage of the STR to lower risks of kidney and bone damage than observed in regimens based on TDF.

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“…Yet, if something was learned from the original conception of the epidemiological transition is that long term trends of change in population’s health cannot be overlooked, from larger global and regionals health and development agendas. For example, today’s world also host millions of people currently living with HIV, which has now become a chronic condition whose cardiovascular conditions might be neglected [81]. …”

Section: Unifying Global Transitions and The Practice Of Global Healtmentioning

confidence: 99%

Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors

Mendoza¹,

Miranda

2017

Cardiology Clinics

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One of the major drivers of change in the practice of cardiology, in both developed and developing countries, is population change, whose dynamics can be expressed by secular epidemiological and demographic trends, with increasing survival and life expectancy across all age strata. The sole concept of transition, whether epidemiological or demographic, is quite dynamic. From a global health point of view, one element merits attention: developed countries have had longer time to double or triple their population, usually more than one century, whereas the same increases in population size in the developing world occurred just over decades. The epidemiological transition theory, far from being perfect, introduced a booster to the understanding of the changing dynamics of epidemiological profiles and provided a complement to the discourse of the demographic change. In this article, with an special emphasis on the challenges faced by low- and middle-income settings, we describe current debates of the epidemiological transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health systems, prevention and treatment efforts; and physiological traits and human-environment interactions are identified. These challenges provide also an opportunity to redefine the agenda of global health cardiology and global cardiovascular research. This article concludes that a focus on the most populated regions of the world, who bear the highest disease burden related to cardiovascular conditions, will contribute substantially to protect the large gains in global survival and life expectancy accrued over the last decades. It then follows that a renewed workforce in global health cardiology must swiftly adapt to these changing environments. As the world changes, the practice of cardiology, clinical cardiology, global health cardiology and cardiology research will follow suit.

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Cost of noninfectious comorbidities in patients with HIV

Cited by 47 publications

References 39 publications

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population

A cost-effectiveness analysis of E/C/F/TAF vs three boosted regimens in the Italian context

Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors

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