Economic evaluation of HIV treatments: The I.CO.N.A. cohort study

Merito, Monica; Bonaccorsi, Andrea; Pammolli, Fabio; Riccaboni, Massimo; Baio, Gianluca; Arici, Claudio; Monforte, Antonella d’Arminio; Pezzotti, Patrizio; Corsini, D; Tramarin, Andrea; Cauda, Roberto; Colangeli, Vincenzo; Pastore, Giuseppe

doi:10.1016/j.healthpol.2005.01.016

Cited by 11 publications

(8 citation statements)

References 18 publications

(19 reference statements)

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“…They found that annual costs of care had remained relatively stable for most HIV patients, except those with CD4 counts <75 cells/mL [41]. Some studies have stated that, although overall annual costs have remained similar throughout the combination ART era, the cost distribution has changed, with a progressive decline in inpatient costs and increase in ART costs [42]. This is not consistent with studies that were published more recently, however [41].…”

Section: Discussionmentioning

confidence: 98%

Newer drugs and earlier treatment

Sloan

Champenois

Choisy

et al. 2012

Aids

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Objective To determine the component costs of care to optimize treatment with limited resources. Design We used the Cost-Effectiveness of Preventing AIDS Complications Model of HIV disease and treatment to project life expectancy (LE) and both undiscounted and discounted lifetime costs (2010€). Methods We determined medical resource utilization among HIV-infected adults followed from 1998 to 2005 in Northern France. Monthly HIV costs were stratified by CD4 count. Costs of CD4, HIV RNA and genotype tests and antiretroviral therapy (ART) were derived from published literature. Model inputs from national data included mean age 38 years, mean initial CD4 count 372/µl, ART initiation at CD4 counts <350/µl, and ART regimen costs ranging from €760/month to €2,570/month. Results The model projected a mean undiscounted LE of 26.5 years and a lifetime undiscounted cost of €535,000/patient (€320,700 discounted); 73% of costs were ART-related. When patients presented to care with mean CD4 counts of 510/µl and initiated ART at CD4 counts <500/µl or HIV RNA >100,000 copies/ml, LE was 27.4 years and costs increased 1–2%, to €546,700 (€324,500 discounted). When we assumed introducing generic drugs would result in a 50% decline in first-line ART costs, lifetime costs decreased 4–6%, to €514,200 (€302,800 discounted). Conclusions As HIV disease is treated earlier with more efficacious drugs, survival and thus costs of care will continue to increase. The availability in high-income countries of widely-used antiretroviral drugs in generic form could reduce these costs.

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Section: Discussionmentioning

confidence: 98%

Newer drugs and earlier treatment

Sloan

Champenois

Choisy

et al. 2012

Aids

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“…Some of these ARVs are now available as cost-free treatment. Merito et al [8] showed that the average annual cost of ARVs increased with the duration of treatment, while inpatient costs decreased. Bruno et al [9] showed the total expense shifted from inpatient costs to ARV medication expenses.…”

Section: Discussionmentioning

confidence: 99%

Expenditures for the care of HIV-infected patients in rural areas in China's antiretroviral therapy programs

Zhou

Kominski

Qian

et al. 2011

BMC Med

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BackgroundThe Chinese government has provided health services to those infected by the human immunodeficiency virus (HIV) under the acquired immunodeficiency syndrome (AIDS) care policy since 2003. Detailed research on the actual expenditures and costs for providing care to patients with AIDS is needed for future financial planning of AIDS health care services and possible reform of HIV/AIDS-related policy. The purpose of the current study was to determine the actual expenditures and factors influencing costs for untreated AIDS patients in a rural area of China after initiating highly active antiretroviral therapy (HAART) under the national Free Care Program (China CARES).MethodsA retrospective cohort study was conducted in Yunnan and Shanxi Provinces, where HAART and all medical care are provided free to HIV-positive patients. Health expenditures and costs in the first treatment year were collected from medical records and prescriptions at local hospitals between January and June 2007. Multivariate linear regression was used to determine the factors associated with the actual expenditures in the first antiretroviral (ARV) treatment year.ResultsFive ARV regimens are commonly used in China CARES: zidovudine (AZT) + lamivudine (3TC) + nevirapine (NVP), stavudine (D4T) + 3TC + efavirenz (EFV), D4T + 3TC + NVP, didanosine (DDI) + 3TC + NVP and combivir + EFV. The mean annual expenditure per person for ARV medications was US$2,242 (US$1 = 7 Chinese Yuan (CNY)) among 276 participants. The total costs for treating all adverse drug events (ADEs) and opportunistic infections (OIs) were US$29,703 and US$23,031, respectively. The expenses for treatment of peripheral neuritis and cytomegalovirus (CMV) infections were the highest among those patients with ADEs and OIs, respectively. On the basis of multivariate linear regression, CD4 cell counts (100-199 cells/μL versus <100 cells/μL, P = 0.02; and ≥200 cells/μL versus <100 cells/μL, P < 0.004), residence in Mangshi County (P < 0.0001), ADEs (P = 0.04) and OIs (P = 0.02) were significantly associated with total expenditures in the first ARV treatment year.ConclusionsThis is the first study to determine the actual costs of HIV treatment in rural areas of China. Costs for ARV drugs represented the major portion of HIV medical expenditures. Initiating HAART in patients with higher CD4 cell count levels is likely to reduce treatment expenses for ADEs and OIs in patients with AIDS.

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“…In high-income countries, the medical advances of recent years have yet to produce a cure, although they have been able to increase the life expectancy and improve the quality of life of the virus carriers, as well as delay the terminal stage of the disease [ 6 ]. As a consequence of advances in therapy since the mid-90s, several reports have documented a shift in HIV/AIDS health service utilization from inpatient to outpatient care in developed countries since the introduction of Highly Active Antiretroviral Therapy (HAART) [ 7 , 8 ]. Most economic assessments carried out in this area deal with the determination of direct costs (prevention, diagnosis and treatment of HIV disease).…”

Section: Introductionmentioning

confidence: 99%

The economic costs and health-related quality of life of people with HIV/AIDS in the Canary Islands, Spain

López-Bastida

Oliva‐Moreno

Perestelo-Pérez

et al. 2009

BMC Health Serv Res

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BackgroundThe objective was to determine the economic burden, as well as the impact on HRQOL for people with HIV/AIDS in Spain in 2003.MethodsA cross-sectional study of 572 people with HIV were recruited from outpatient clinics in the Canary Islands, Spain. Demographic, health resources utilization, indirect costs and quality of life data were collected through medical records and questionnaires filled out by people with HIV. HRQOL was measured with two generic questionnaires: SF-36 and EQ-5D.ResultsIn 2003 annual costs of caring for patients with asymptomatic HIV, symptomatic HIV and AIDS were €10,351, €14,489 and €15,750, respectively. The HRQOL with the EQ-5D was 0.78. SF-36 summary results for physical and mental health were 48.30 and 38.80, respectively.ConclusionHIV/AIDS represent a high economic impact from society point of view. the structure of health care costs have changed due to these new drugs, increasing the weight of pharmaceutical treatment over total costs and decreasing the importance of inpatient care costs. In spite of the therapeutic improvements, labour losses/indirect costs still represent a high cost. Costs and HRQOL were strongly associated with severity. Although the latest drug developments have not yet been able to find the definitive cure, they have allowed an improvement in expectancy of life and in the HRQOL of the patients.

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Economic evaluation of HIV treatments: The I.CO.N.A. cohort study

Cited by 11 publications

References 18 publications

Newer drugs and earlier treatment

Newer drugs and earlier treatment

Expenditures for the care of HIV-infected patients in rural areas in China's antiretroviral therapy programs

The economic costs and health-related quality of life of people with HIV/AIDS in the Canary Islands, Spain

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