Newer drugs and earlier treatment

Abstract

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.

Direct treatment costs of HIV/AIDS in Portugal

“…5,13 The major discrepancy is driven by the last stage of disease (average cost of € 25,013 for Portugal, € 38,014 for France, in 2012 prices), essentially due to differences in hospitalization costs (€ 8,371 versus € 15,586, in 2012 prices). This discrepancy is certainly due in part to differences in severity between patients in the final stage of disease; our sample does not include any patient who died during the study period, while this was the case for more than 2,000 individuals-month in Sloan et al These cases represent by far the highest expenditures.…”

“…4 A common pattern in these studies is that ART cost is relatively stable across CD4 strata, hence the major source of increase is due to other drugs and hospitalizations. Sloan et al 13 and Krentz et al, 4 who both consider longer periods, show that ART-related costs have been quite stable over time; hence, the small increases in yearly costs are essentially due to other components, with marked effects at later stages of disease. Recent contributions clarify the role of late presentation in substantially increasing immediate costs after treatment initiation.…”

“…Recent contributions clarify the role of late presentation in substantially increasing immediate costs after treatment initiation. 13 The perspective is that of the National Health Service (NHS), given that private facilities did not treat HIV cases at the time our study was performed. The 2011 Portuguese GDP per capita adjusted for inflation and purchasing power parity ($ 21,414) is lower than that of other high-income countries for which similar analyses have been performed, namely Belgium ($ 33,217), France ($ 29,938), Germany ($ 34,581), Italy ($ 27,053), Switzerland ($ 39,600), and the US ($ 42,385).…”

“…"Hot" questions concern the opportunity for expanded testing and early detection, pre-exposure prophylaxes, regular lab tests for CD4 cell count and viral load, choice of regimen options and treatment initiation thresholds in the HIV area. 3,10,11,13 These complex issues require valid figures on treatment costs. As Schackman et al 12 indicate, "if policy makers rely on outdated estimates of HIV care costs, treatment programs will be under-funded and the economic value of HIV prevention will be understated" (p.990).…”

Cultural adaptation of Quality Of Care Through The Patient's Eyes -QUOTE-HIV

“…From the beginning of the epidemic to the present day, the disease has progressed in a complex, chronic and controllable way. The quality of life of people infected with the virus has improved considerably, thanks to the set of procedures available for their treatment (highly effective antiretroviral therapy, medicines for prophylaxis of opportunistic diseases, routine immunizations, periodic medical examinations and consultations, and health programs) (4)(5) . However, maintaining the quality of care provided and guaranteeing patients' adherence to care programs will continue to be a challenge for health professionals.…”