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Kalidasan V, Kunalan I, Rajasuriar R, Subbiah VK, Das KT. HLA-B*57:01 typing in a Malaysian cohort: implications of abacavir hypersensitivity in people living with HIV. Pharmacogenomics 2023; 24:761-769. [PMID: 37767641 DOI: 10.2217/pgs-2023-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Background: Abacavir (ABC) in combination with other antiretroviral drugs, is used to treat people living with HIV (PLWH). However, it is linked to a fatal hypersensitivity reaction in susceptible individuals, and is strongly associated with the HLA-B*57:01 allele. Materials & methods: A total of 152 patients, 50 PLWH and 102 HIV-1 negative patients, were assessed for the HLA-B*57:01 allele through a sequence-specific primer PCR. Results: All PLWH tested negative for the HLA-B*57:01 allele, but two HIV-negative patients were found to have HLA-B*57, with one of them expressing the HLA-B*57:01 allele. Conclusion: Given the low prevalence of this risk allele in the population, testing for the presence of HLA-B*57:01 in PLWH may not provide significant benefit for the reported population.
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Affiliation(s)
- V Kalidasan
- Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Penang, Malaysia
| | - Iswarya Kunalan
- Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Penang, Malaysia
- School of Biological Sciences, Universiti Sains Malaysia, 11700, Gelugor, Penang, Malaysia
| | - Reena Rajasuriar
- Department of Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Centre of Excellence Research in AIDS (CERiA), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Vijay Kumar Subbiah
- Biotechnology Research Institute, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Kumitaa Theva Das
- Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Penang, Malaysia
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Barry M, Ghonem L, Albeeshi N, Alrabiah M, Alsharidi A, Al-Omar HA. Resource Utilization and Caring Cost of People Living with Human Immunodeficiency Virus (PLHIV) in Saudi Arabia: A Tertiary Care University Hospital Experience. Healthcare (Basel) 2022; 10:118. [PMID: 35052282 PMCID: PMC8776132 DOI: 10.3390/healthcare10010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
The human immunodeficiency virus (HIV) is associated with a significant burden of disease, including medical and non-medical costs. Therefore, it is considered to be a priority for all health authorities. The aim of this study is to determine healthcare and treatment costs of caring for PLHIV at one of the tertiary care university hospitals in Riyadh, Saudi Arabia. This was a micro-costing, retrospective, observational study from a tertiary care university hospital and included all confirmed HIV-infected patients who visited infectious disease clinics in the period from 1 January 2015 to 31 December 2018. A total of 42 PLHIV were included in this study. The mean age of the study participants was 38.76 ± 11.47 years with a mean disease duration of 5.27 ± 4.81 years. The majority of patients were male (85.7%) and Saudi (88.1%). More than half of included patients (59.5%) had a CD4 count of more than 500. During the study period, 26 patients (61.9%) were initiated on a single-tablet regimen. Overall, the main cost-driver was antiretroviral medications, which cumulatively represented more than 64% of the total cost. Patients who developed opportunistic infections had a statistically significant (p = 0.033) higher financial impact, both as a total and on a patient level, than those presented without opportunistic infections. On a patient level, the mean and median costs were higher and statistically significant for those with co-morbidities than those without co-morbidities (p = 0.002). The majority of the economic burden of PLHIV is attributable to antiretroviral therapy use. The healthcare costs of PLHIV can vary greatly, depending on the presenting illness, clinical stage, developed opportunistic infection, co-morbidity, and pharmacological therapy.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 11451, Saudi Arabia; (M.B.); (A.A.)
| | - Leen Ghonem
- Department of Pharmacy, King Saud University Medical City, Riyadh 12372, Saudi Arabia;
| | - Nourah Albeeshi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Maha Alrabiah
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 12372, Saudi Arabia;
| | - Aynaa Alsharidi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh 11451, Saudi Arabia; (M.B.); (A.A.)
| | - Hussain Abdulrahman Al-Omar
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Health Technology Assessment Unit, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Churchill D, Waters L, Ahmed N, Angus B, Boffito M, Bower M, Dunn D, Edwards S, Emerson C, Fidler S, Fisher M, Horne R, Khoo S, Leen C, Mackie N, Marshall N, Monteiro F, Nelson M, Orkin C, Palfreeman A, Pett S, Phillips A, Post F, Pozniak A, Reeves I, Sabin C, Trevelion R, Walsh J, Wilkins E, Williams I, Winston A. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2018; 17 Suppl 4:s2-s104. [PMID: 27568911 DOI: 10.1111/hiv.12426] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Mark Bower
- Chelsea and Westminster Hospital, London, UK
| | | | - Simon Edwards
- Central and North West London NHS Foundation Trust, UK
| | | | - Sarah Fidler
- Imperial College School of Medicine at St Mary's, London, UK
| | | | | | | | | | | | | | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Royal Free and University College Medical School, London, UK
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian Williams
- Royal Free and University College Medical School, London, UK
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Costs and cost-efficacy analysis of the 2017 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2017; 36:268-276. [PMID: 28532596 DOI: 10.1016/j.eimc.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION GESIDA and the Spanish National AIDS Plan panel of experts have recommended preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral therapy (ART) as initial therapy in HIV-infected patients for 2017. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR. METHODS Economic assessment of costs and efficiency (cost-efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, resistance studies and HLA B*5701 screening. The setting was Spain and the costs correspond to those of 2017. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. RESULTS In the base case scenario, the cost of initiating treatment ranged from 6882 euro for TFV/FTC/RPV (AR) to 10,904 euros for TFV/FTC+RAL (PR). The efficacy varied from 0.82 for TFV/FTC+DRV/p (AR) to 0.92 for TAF/FTC/EVG/COBI (PR). The efficiency, in terms of cost-efficacy, ranged from 7923 to 12,765 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TFV/FTC+RAL (PR), respectively. CONCLUSION Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TFV/FTC/RPV (AR) and TAF/FTC/EVG/COBI (PR).
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Rivero A, Pérez-Molina JA, Blasco AJ, Arribas JR, Crespo M, Domingo P, Estrada V, Iribarren JA, Knobel H, Lázaro P, López-Aldeguer J, Lozano F, Moreno S, Palacios R, Pineda JA, Pulido F, Rubio R, de la Torre J, Tuset M, Gatell JM. Costs and cost-efficacy analysis of the 2016 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2016; 35:88-99. [PMID: 27459919 DOI: 10.1016/j.eimc.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION GESIDA and the AIDS National Plan panel of experts suggest preferred (PR), alternative (AR), and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for the year 2016. The objective of this study is to evaluate the costs and the efficacy of initiating treatment with these regimens. METHODS Economic assessment of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48 in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2016. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable, and least favourable. RESULTS In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,894 Euros for TDF/FTC+RAL (PR). The efficacy varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/efficacy, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR), and RAL+DRV/r (OR), respectively. CONCLUSION Despite the overall most efficient regimen being 3TC+LPV/r (OR), among the PR and AR, the most efficient regimen was ABC/3TC/DTG (PR). Among the AR regimes, the most efficient was TDF/FTC/RPV.
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Affiliation(s)
- Antonio Rivero
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | | | - José Ramón Arribas
- Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Manuel Crespo
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Pere Domingo
- Hospitals Universitaris Arnau de Vilanova & Santa María, Universitat de Lleida, Institut de Recerca Biomèdica (IRB) de Lleida, Lieida, Spain
| | - Vicente Estrada
- Hospital Clínico San Carlos, IdISSC; Universidad Complutense, Madrid, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Hernando Knobel
- Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain
| | | | - José López-Aldeguer
- Servicio de Medicina Interna y Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Valencia, Spain
| | - Fernando Lozano
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Rosario Palacios
- Unidad de Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain
| | - Juan Antonio Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Federico Pulido
- Unidad VIH, i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Rubio
- Unidad VIH, i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier de la Torre
- Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | | | - Josep M Gatell
- Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
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Costs and cost-effectiveness analysis of 2015 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2015; 34:361-71. [PMID: 26321131 DOI: 10.1016/j.eimc.2015.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION GESIDA and the AIDS National Plan panel of experts suggest a preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2015. The objective of this study is to evaluate the costs and the effectiveness of initiating treatment with these regimens. METHODS Economic assessment of costs and effectiveness (cost/effectiveness) based on decision tree analyses. Effectiveness was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2015. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. RESULTS In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,902 Euros for TDF/FTC+RAL (PR). The effectiveness varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/effectiveness, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR) and RAL+DRV/r (OR), respectively. CONCLUSION The most efficient regimen was 3TC+LPV/r (OR). Among the PR and AR, the most efficient regimen was TDF/FTC/RPV (AR). Among the PR regimes, the most efficient was ABC/3TC+DTG.
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Brennan A, Jackson A, Horgan M, Bergin CJ, Browne JP. Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study. BMC Health Serv Res 2015; 15:139. [PMID: 25884351 PMCID: PMC4393598 DOI: 10.1186/s12913-015-0816-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/23/2015] [Indexed: 11/16/2022] Open
Abstract
Background It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications. Methods A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Ireland. The costs of individual appointment types were estimated based on staff grade and time. Hospital resources used by HIV patients who attended the ambulatory care service in 2012 were identified and extracted from existing hospital systems. Associations between patient characteristics and costs per patient month, in 2012 euros, were examined using univariate and multivariate analyses. Results The average cost of providing ambulatory HIV care was found to be €973 (95% confidence interval €938 - €1008) per patient month in 2012. Sensitivity analysis, varying the base-case staff time estimates by 20% and diagnostic testing costs by 60%, estimated the average cost to vary from a low of €927 per patient month to a high of €1019 per patient month. The vast majority of costs were due to the cost of HAART. Women were found to have significantly higher HAART costs per patient month while patients over 50 years of age had significantly lower HAART costs using multivariate analysis. Conclusions This study provides the estimated cost of ambulatory care in a regional HIV centre in Ireland. These data are valuable for planning services at a local level, and the identification of patient factors, such as age and gender, associated with resource use is of interest both nationally and internationally for the long-term planning of HIV care provision.
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Affiliation(s)
- Aline Brennan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
| | - Arthur Jackson
- Cork University Hospital and Mercy University Hospital Cork, Cork, Ireland.
| | - Mary Horgan
- School of Medicine, University College Cork and Cork University Hospital, Cork, Ireland.
| | - Colm J Bergin
- St James's Hospital, Dublin and Trinity College Dublin, Dublin, Ireland.
| | - John P Browne
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
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Boussari O, Subtil F, Genolini C, Bastard M, Iwaz J, Fonton N, Etard JF, Ecochard R. Impact of variability in adherence to HIV antiretroviral therapy on the immunovirological response and mortality. BMC Med Res Methodol 2015; 15:10. [PMID: 25656082 PMCID: PMC4429708 DOI: 10.1186/1471-2288-15-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/21/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Several previous studies have shown relationships between adherence to HIV antiretroviral therapy (ART) and the viral load, the CD4 cell count, or mortality. However, the impact of variability in adherence to ART on the immunovirological response does not seem to have been investigated yet. METHODS Monthly adherence data (November 1999 to April 2009) from 317 HIV-1 infected patients enrolled in the Senegalese ART initiative were analyzed. Latent-class trajectory models were used to build typical trajectories for the average adherence and the standardized variance of adherence. The relationship between the standardized variance of adherence and each of the change in CD4 cell count, the change in viral load, and mortality were investigated using, respectively, a mixed linear regression, a mixed logistic regression, and a Cox model with time-dependent covariates. All the models were adjusted on the average adherence. RESULTS Three latent trajectories for the average adherence and three for the standardized variance of adherence were identified. The increase in CD4 cell count and the increase in the percentage of undetectable viral loads were negatively associated with the standardized variance of adherence but positively associated with the average adherence. The risk of death decreased significantly with the increase in the average adherence but increased significantly with the increase of the standardized variance of adherence. CONCLUSIONS The impacts of the level and the variability of adherence on the immunovirological response and survival justify the inclusion of these aspects into the process of patient education: adherence should be both high and constant.
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Affiliation(s)
- Olayidé Boussari
- Mathematical Physics and Applications, Laboratoire d'Etude et de Recherche en Statistique Appliquée et Modélisation, Université d'Abomey-Calavi, Abomey-Calavi, Bénin.
- Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France.
- Université de Lyon, F-69000, Lyon, France.
- Université Lyon 1, F-69100, Villeurbanne, France.
- CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France.
| | - Fabien Subtil
- Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France.
- Université de Lyon, F-69000, Lyon, France.
- Université Lyon 1, F-69100, Villeurbanne, France.
- CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France.
| | - Christophe Genolini
- INSERM, UMR 1027, Research Unit on Perinatal Epidemiology and Childhood Disabilities, Adolescent Health, F-31062, Toulouse, France.
- CeRSM (EA 2931), UFR STAPS, Université Paris Ouest Nanterre La Défense, F-92001, Nanterre, France.
| | | | - Jean Iwaz
- Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France.
- Université de Lyon, F-69000, Lyon, France.
- Université Lyon 1, F-69100, Villeurbanne, France.
- CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France.
| | - Noël Fonton
- Mathematical Physics and Applications, Laboratoire d'Etude et de Recherche en Statistique Appliquée et Modélisation, Université d'Abomey-Calavi, Abomey-Calavi, Bénin.
| | - Jean-François Etard
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement, Université Montpellier 1, F-34394, Montpellier, France.
| | - René Ecochard
- Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France.
- Université de Lyon, F-69000, Lyon, France.
- Université Lyon 1, F-69100, Villeurbanne, France.
- CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100, Villeurbanne, France.
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Blasco AJ, Llibre JM, Berenguer J, González-García J, Knobel H, Lozano F, Podzamczer D, Pulido F, Rivero A, Tuset M, Lázaro P, Gatell JM. Costs and cost-efficacy analysis of the 2014 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2014; 33:156-65. [PMID: 25175171 DOI: 10.1016/j.eimc.2014.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/19/2014] [Accepted: 05/25/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION GESIDA and the National AIDS Plan panel of experts suggest preferred (PR) and alternative (AR) regimens of antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2014. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these regimens. METHODS An economic assessment was made of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied by considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and costs correspond to those of 2014. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. RESULTS In the base case scenario, the cost of initiating treatment ranges from 5133 Euros for ABC/3TC+EFV to 11,949 Euros for TDF/FTC+RAL. The efficacy varies between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.89 for TDF/FTC/EVG/COBI. Efficiency, in terms of cost/efficacy, ranges from 7546 to 13,802 Euros per responder at 48 weeks, for ABC/3TC+EFV and TDF/FTC+RAL respectively. CONCLUSION Considering ART official prices, the most efficient regimen was ABC/3TC+EFV (AR), followed by the non-nucleoside containing PR (TDF/FTC/RPV and TDF/FTC/EFV). The sensitivity analysis confirms the robustness of these findings.
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Affiliation(s)
| | - Josep M Llibre
- Fundació Lluita contra la Sida, Unitat VIH, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan González-García
- Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Hernando Knobel
- Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain
| | - Fernando Lozano
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Daniel Podzamczer
- Unidad VIH, Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, Spain
| | - Federico Pulido
- Unidad de VIH, Hospital Universitario 12 de Octubre, i+12, Madrid, Spain
| | - Antonio Rivero
- Sección de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Pablo Lázaro
- Técnicas Avanzadas de Investigación en Servicios de Salud (TAISS), Madrid, Spain
| | - Josep M Gatell
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
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11
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Blasco AJ, Llibre JM, Arribas JR, Boix V, Clotet B, Domingo P, González-García J, Knobel H, López JC, Lozano F, Miró JM, Podzamczer D, Santamaría JM, Tuset M, Zamora L, Lázaro P, Gatell JM. [Analysis of costs and cost-effectiveness of preferred GESIDA/National AIDS Plan regimens for initial antiretroviral therapy in human immunodeficiency virus infected adult patients in 2013]. Enferm Infecc Microbiol Clin 2013; 31:568-78. [PMID: 23969276 DOI: 10.1016/j.eimc.2013.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/28/2013] [Accepted: 06/02/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The GESIDA and National AIDS Plan panel of experts have proposed "preferred regimens" of antiretroviral treatment (ART) as initial therapy in HIV infected patients for 2013. The objective of this study is to evaluate the costs and effectiveness of initiating treatment with these "preferred regimens". METHODS An economic assessment of costs and effectiveness (cost/effectiveness) was performed using decision tree analysis models. Effectiveness was defined as the probability of having viral load <50copies/mL at week48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and its consequences (adverse effects, changes of ART regime and drug resistance analyses) during the first 48weeks. The perspective of the analysis is that of the National Health System was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, resistance studies, and determination of HLA B*5701. The setting is Spain and the costs are those of 2013. A sensitivity deterministic analysis was performed, constructing three scenarios for each regimen: baseline, most favourable, and most unfavourable cases. RESULTS In the baseline case scenario, the cost of initiating treatment ranges from 6,747euros for TDF/FTC+NVP to 12,059euros for TDF/FTC+RAL. The effectiveness ranges between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.87 for TDF/FTC+RAL and ABC/3TC+RAL. Effectiveness, in terms of cost/effectiveness, varies between 8,396euros and 13,930euros per responder at 48weeks, for TDF/FTC/RPV and TDF/FTC+RAL, respectively. CONCLUSIONS Taking ART at official prices, the most effective regimen was TDF/FTC/RPV, followed by the rest of non-nucleoside containing regimens. The sensitivity analysis confirms the robustness of these findings.
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Horberg M, Raymond B. Financial policy issues for HIV pre-exposure prophylaxis: cost and access to insurance. Am J Prev Med 2013; 44:S125-8. [PMID: 23253752 DOI: 10.1016/j.amepre.2012.09.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/05/2012] [Accepted: 09/19/2012] [Indexed: 11/20/2022]
Affiliation(s)
- Michael Horberg
- Mid-Atlantic Permanente Research Institute, Rockville, Maryland 20852, USA.
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Colombie V, Pugliese-Wehrlen S, Deuffic-Burban S, Cuzin L, Pugliese P, Katlama C, Poizot-Martin I, Raffi F, Cabie A, Dellamonica P, Yazdanpanah Y, Dat'Aids. Mean cost of a first combination antiretroviral therapy in HIV-infected patients in France, and determinants of expensive drugs prescription. Int J STD AIDS 2012; 23:865-9. [DOI: 10.1258/ijsa.2012.011438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To estimate the cost of the first combination antiretroviral drug therapy (cART) in HIV-infected patients and to determine factors associated with expensive prescriptions, 1698 patients starting cART between September 2002 and September 2007 were selected from the Dat'AIDS cohort. A multivariate linear regression model was used to assess associations between the cost of first cART and patient characteristics, clinical centre and cART adequacy. At cART initiation, the median age was 39 years, median CD4 count was 223 cells/mm3, median viral load (VL) was 5.2 log copies/mL and 18.3% presented with AIDS. cART was concordant with the French guidelines in 88.7%. The mean cost of cART varied from €26.69/day/person in 2002-2003 to €32.23 in 2006-2007 ( P < 0.0001), cost was associated with previous AIDS diagnosis (€31.83/day/person) versus (29.49; P < 0.0001), baseline VL > 5 log copies/mL (€30.99/day/person) versus (28.33; P < 0.0001) and centre. cART regimen not concordant with guidelines were more expensive (€38.31/day/person) versus (29.07; P < 0.0001). After adjusting for the year of initiation, the previous AIDS diagnosis, VL and recommended cART regimen, differences were still found between centres (from €27.81/day/person) to (33.12; P < 0.0001). Cost should be considered when choosing a first cART regimen, especially when considering clinically equivalent regimens.
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Affiliation(s)
- V Colombie
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Régional de Tourcoing, Faculté de Lille, Lille
| | - S Pugliese-Wehrlen
- Pharmacie Archet, Pôle Pharmacie, Centre Hospitalier Universitaire de Nice, Nice
| | | | - L Cuzin
- Service Universitaire des Maladies Infectieuses, Centre Hospitalier Universitaire de Toulouse, Toulouse
| | - P Pugliese
- Service Universitaire des Maladies Infectieuses, Centre Hospitalier Universitaire de Nice, Nice
| | - C Katlama
- Service Universitaire d'Immuno-Hématologie Clinique Hôspital Pitié-Salpètrière, Centre d'Informations et de soins de Nmmunodéficience Humaine et des hépatites Virales, Paris
| | - I Poizot-Martin
- Aix Marseille Univ, APHM Sainte-Marguerite, Service d'Immuno-hématologie clinique, Inserm U912 (SESSTIM), Marseille
| | - F Raffi
- Service Universitaire des Maladies Infectieuses, Centre Hospitalier Universitaire de Nantes, Nantes
| | - A Cabie
- Service d'Infectiologie Universitaire des Maladies Infectieuses, Centre Hospitalier Universitaire de Fort-de-France, Martinique
| | - P Dellamonica
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Régional de Tourcoing, Faculté de Lille, Lille
- ATIP-Avenir INSERM U783, Paris
| | - Y Yazdanpanah
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Régional de Tourcoing, Faculté de Lille, Lille
- ATIP-Avenir INSERM U783, Paris
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Blasco AJ, Arribas JR, Boix V, Clotet B, Domingo P, González-García J, Knobel H, López JC, Llibre JM, Lozano F, Miró JM, Podzamczer D, Santamaría JM, Tuset M, Zamora L, Lázaro P, Gatell JM. [Costs and cost-efficacy analysis of the preferred treatments by GESIDA/National Plan for AIDS for the initial antiretroviral therapy in adult human immunodeficiency virus (HIV) infected patients in 2012]. Enferm Infecc Microbiol Clin 2012; 30:283-93. [PMID: 22525829 DOI: 10.1016/j.eimc.2012.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The GESIDA and National AIDS Plan panel of experts propose «preferred regimens» of antiretroviral treatment (ART) as initial therapy in HIV infected patients for 2012. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these «preferred regimens». METHODS Economic assessment of costs and efficiency (cost/efficacy) using decision tree analysis model. Efficacy was defined as the probability of having a viral load <50 copies/ml at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and all its consequences (adverse effects, changes of ART regime, and drug resistance analyses) during the first 48 weeks. The perspective of the analysis is that of the National Health System, considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance and determination of HLA B 5701. The setting is Spain and the costs are those of 2012. A sensitivity deterministic analysis was conducted, building three scenarios for each regime: baseline, most favourable, and most unfavourable cases. RESULTS In the baseline case scenario, the cost of initiating treatment ranges from 6,895 euros for TDF/FTC+NVP to 12,067 euros for TDF/FTC+RAL. The efficacy ranges between 0.66 for ABC/3TC+LPV/r and 0.87 for TDF/FTC+RAL. Efficiency, in terms of cost/efficacy, varies between 9,387 and 13,823 euros per responder at 48 weeks, for TDF/FTC/EFV and TDF/FTC+RAL, respectively. In the most unfavourable scenario, the most efficient regime is TDF/FTC+NVP (9,742 per responder). CONCLUSION Considering the official prices of ART, the most efficient regimens are TDF/FTC/EFV (baseline case and most favourable scenarios), and TDF/FTC+NVP (most unfavourable scenario).
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Blasco AJ, Arribas JR, Clotet B, Domingo P, González-García J, López-Bernaldo JC, Llibre JM, Lozano F, Podzamczer D, Santamaría JM, Tuset M, Zamora L, Lázaro P, Gatell JM. [Costs and cost effectiveness analysis of preferred GESIDA regimens for initial antiretroviral therapy]. Enferm Infecc Microbiol Clin 2011; 29:721-30. [PMID: 22014894 DOI: 10.1016/j.eimc.2011.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 08/01/2011] [Accepted: 08/04/2011] [Indexed: 10/16/2022]
Abstract
INTRODUCTION GESIDA (AIDS Study Group) and the National AIDS Plan panel of experts propose "preferred regimens" of antiretroviral treatment (ART) as initial therapy in HIV infected patients. These preferred regimens are based on the results of clinical trials, and on the opinions of the experts of the panel. The objective of this study is to evaluate the costs and the cost effectiveness of initiating treatment following these guidelines. METHODS Economic assessment of costs and cost effectiveness through the construction of decision trees. Effectiveness was defined as the probability of having viral load <50 copies/mL at week 48 in an intention-to-treat analysis. The perspective of the analysis is that of the National Health System, taking into account only the differential direct costs (ART, management of adverse effects, studies of resistance, and determination of HLA B * 5701). The area is Spain, the time horizon is 48 weeks, and the costs are those of 2011. A deterministic sensitivity analysis was performed, building three scenarios for each regimen: baseline, the most favourable, and the most unfavourable. RESULTS In the baseline scenario, the cost of initiating treatment ranges from 7,550 Euros for the ABC/3TC+EFV to 13,327 Euros for TDF/FTC+RAL. The efficacy ranges between 0.66 for ABC/3TC+LPV/r and 0.86 for TDF/FTC+RAL. Efficiency, in terms of cost effectiveness, varies between 10,175 and 15,539 Euros per responder at 48 weeks, for TDF/FTC/EFV and TDF/FTC+RAL respectively. CONCLUSION The most efficient regimen was TDF/FTC+EFV, followed by ABC/3TC+EFV. Sensitivity analysis confirms the robustness of these findings.
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Revisiting long-term adherence to highly active antiretroviral therapy in Senegal using latent class analysis. J Acquir Immune Defic Syndr 2011; 57:55-61. [PMID: 21775934 DOI: 10.1097/qai.0b013e318211b43b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence is one of the main predictors of antiretroviral treatment success. A governmental initiative was launched in 1998 for HIV-infected patients in Senegal to provide access to highly active antiretroviral therapy. METHODS Between August 1998 and April 2002, 404 adult patients were enrolled. Adherence measurements, defined as pills taken/pills prescribed, were assessed between November 1999 and April 2009 using a pill count along with a questionnaire for 330 patients. Predictors of adherence were explored through a random-intercept Tobit model and a latent class analysis (LCA) was performed to identify adherence trajectories. We also performed a survival analysis taking into account gender and latent adherence classes. RESULTS Median treatment duration was 91 months (interquartile range, 84-101). On average, adherence declined by 7% every year, was 30% lower for patients taking indinavir, and 12% higher for those receiving cotrimoxazole prophylaxis. Based on the predicted probability of having an adherence ≥ 95%, LCA revealed 3 adherence behaviors and a better adherence for women. A quarter of patients had a high adherence trajectory over time and half had an intermediate one. Male gender and low adherence behavior over time were independently associated with a higher mortality rate. CONCLUSIONS This study shows that an overall good adherence can be obtained in the long term in Senegal. LCA suggests a better adherence for women and points out a large subsample of patients with intermediate level of adherence behavior who are at risk for developing resistance to antiretroviral drugs. This study warrants further research into gender issues.
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Moreno S, González J, Lekander I, Martí B, Oyagüez I, Sánchez-de la Rosa R, Casado MA. Cost-effectiveness of optimized background therapy plus maraviroc for previously treated patients with R5 HIV-1 infection from the perspective of the Spanish health care system. Clin Ther 2011; 32:2232-45. [PMID: 21316539 DOI: 10.1016/s0149-2918(10)80026-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this work was to evaluate the cost-effectiveness, from the perspective of the Spanish health care system, of optimized background therapy (OBT) plus maraviroc 300 mg BID versus OBT plus placebo in previously treated patients with R5 HIV-1 infection. METHODS A lifetime cohort model was developed, based on 24- and 48-week pooled results from the Maraviroc Versus Optimized Therapy in Viremic Antiretroviral Treatment-Experienced Patients (MOTIVATE) studies 1 and 2, to reflect the Spanish health care system's perspective. Treatment duration was based on clinical trial follow-up from MOTIVATE 1 and 2. Clinical data, cohort characteristics, success probability, CD4 increase rate, CD4 cell status link to disease states, and adverse-event probability were taken from the MOTIVATE trials and other published literature. Other input parameters were taken from published sources. Antiretroviral (ARV) costs were derived from local sources. Non-ARV drug costs were obtained from published literature and a cost database. All costs were calculated as year-2009 euros. The annual discount rate was set at 3.0%. The main outcomes were cost per life-year gained (LYG) and cost per quality-adjusted life-year (QALY) gained. Uncertainty was assessed with one-way and probabilistic sensitivity analyses. RESULTS In the model analysis, adding maraviroc to OBT was associated with an increase of 0.952 LYG and 0.909 QALY. Total costs were €275,970 for maraviroc plus OBT and €254,655 for placebo plus OBT (difference: €21,315). The incremental cost per LYG was €22,398 and the incremental cost per QALY gained was €23,457. The model appeared to be robust for variations in key parameters. Results from the probabilistic sensitivity analyses indicated that the probability of the cost per QALY being below €30,000 was 99%. CONCLUSION Despite the limitations of the model, our analysis suggested that OBT plus maraviroc 300 mg BID is a clinically valuable option, and cost-effective from the perspective of the Spanish health care system, for previously treated patients with R5 HIV-1 infection.
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Smith RJ, Li J, Gordon R, Heffernan JM. Can we spend our way out of the AIDS epidemic? A world halting AIDS model. BMC Public Health 2009; 9 Suppl 1:S15. [PMID: 19922685 PMCID: PMC2779503 DOI: 10.1186/1471-2458-9-s1-s15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background There has been a sudden increase in the amount of money donors are willing to spend on the worldwide HIV/AIDS epidemic. Present plans are to hold most of the money in reserve and spend it slowly. However, rapid spending may be the best strategy for halting this disease. Methods We develop a mathematical model that predicts eradication or persistence of HIV/AIDS on a world scale. Dividing the world into regions (continents, countries etc), we develop a linear differential equation model of infectives which has the same eradication properties as more complex models. Results We show that, even if HIV/AIDS can be eradicated in each region independently, travel/immigration of infectives could still sustain the epidemic. We use a continent-level example to demonstrate that eradication is possible if preventive intervention methods (such as condoms or education) reduced the infection rate to two fifths of what it is currently. We show that, for HIV/AIDS to be eradicated within five years, the total cost would be ≈ $63 billion, which is within the existing $60 billion (plus interest) amount raised by the donor community. However, if this action is spread over a twenty year period, as currently planned, then eradication is no longer possible, due to population growth, and the costs would exceed $90 billion. Conclusion Eradication of AIDS is feasible, using the tools that we have currently to hand, but action needs to occur immediately. If not, then HIV/AIDS will race beyond our ability to afford it.
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Affiliation(s)
- Robert J Smith
- Department of Mathematics and Faculty of Medicine, The University of Ottawa, 585 King Edward Ave, Ottawa, Ontario, Canada, K1N 6N5.
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Barbour KE, Fabio A, Pearlman DN. Inpatient charges among HIV/AIDS patients in Rhode Island from 2000-2004. BMC Health Serv Res 2009; 9:3. [PMID: 19128494 PMCID: PMC2630923 DOI: 10.1186/1472-6963-9-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 01/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inpatient HIV/AIDS charges decreased from 1996-2000. This decrease was mainly attributable to treatment of HIV/AIDS patients with Highly Active Antiretroviral Therapy (HAART). This study aims to evaluate the trend in inpatient charges from 2000-2004. METHODS Rhode Island Hospital Discharge Data (HDD) from 2000 to 2004 was used. International Classification of Disease (ICD-9) diagnosis code 042-044 was used to identify HIV/AIDS admissions. The final study population included 1927 HIV/AIDS discharges. We used a multivariable linear regression model to examine the factors associated with inflation adjusted inpatient charges. RESULTS We found a significant increase in inpatient charges from 2000-2004 after adjusting for length of stay (LOS), gender, age, race and point of entry for hospitalization. In addition to calendar year, LOS, gender and race were also associated with inpatient charges. CONCLUSION HIV/AIDS inpatient charges increased after adjusting for inflation despite earlier studies that showed a decline. Our results have implications for uninsured, as well as insured HIV/AIDS patients who do not have a medical plan that covers their charges sufficiently. Future research should investigate what factors are contributing to rising inpatient charges among HIV/AIDS patients.
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Affiliation(s)
- Kamil E Barbour
- Brown University Program in Public Health, Center for Population Health and Clinical Epidemiology, 121 South Main Street, Providence, RI 02912, USA
- University of Pittsburgh, Center for Aging and Population Health, 130 N Bellefield Avenue, Pittsburgh, PA, 15213, USA
| | - Anthony Fabio
- University of Pittsburgh, Center for Injury Research and Control, 3471 5th Ave # 810, Pittsburgh, PA 15213, USA
| | - Deborah N Pearlman
- Brown University Program in Public Health, Center for Population Health and Clinical Epidemiology, 121 South Main Street, Providence, RI 02912, USA
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Schoeman CS, Pather MK. The clinical spectrum and cost implications of hospitalised HIV-infected children at Karl Bremer Hospital, Cape Town, South Africa. S Afr Fam Pract (2004) 2009. [DOI: 10.1080/20786204.2009.10873807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Cost-effectiveness analysis of emtricitabine/tenofovir versus lamivudine/zidovudine, in combination with efavirenz, in antiretroviral-naive, HIV-1-infected patients. Clin Ther 2008; 30:372-81. [DOI: 10.1016/j.clinthera.2008.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2007] [Indexed: 11/20/2022]
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Jing Y, Klein P, Kelton CML, Li X, Guo JJ. Utilization and spending trends for antiretroviral medications in the U.S. Medicaid program from 1991 to 2005. AIDS Res Ther 2007; 4:22. [PMID: 17937821 PMCID: PMC2147021 DOI: 10.1186/1742-6405-4-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Accepted: 10/16/2007] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV/AIDS incidence and mortality rates have decreased in the U.S. since 1996. Accompanying the longer life spans of those diagnosed with the disease, however, is a tremendous rise in expenditures on medication. The objective of this study is to describe the trends in utilization of, spending on, and market shares of antiretroviral medications in the U.S. Medicaid Program. Antiretroviral drugs include nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), and fusion inhibitors (FIs). METHODS Utilization and payment data from 1991 to 2005 are provided by the Centers for Medicare & Medicaid Services. Descriptive summary analyses were used to assess quarterly prescription numbers and amounts of payment. RESULTS The total number of prescriptions for antiretrovirals increased from 168,914 in 1991 to 2.0 million in 1998, and 3.0 million in 2005, a 16.7-fold increase over 15 years. The number of prescriptions for NRTIs reached 1.6 million in 2005. Prescriptions for PIs increased from 114 in 1995 to 932,176 in 2005, while the number of prescriptions for NNRTIs increased from 1,339 in 1996 to 401,272 in 2005. The total payment for antiretroviral drugs in the U.S. Medicaid Program increased from US$ 30.6 million in 1991 to US$ 1.6 billion in 2005, a 49.8-fold increase. In 2005, NRTIs as a class had the highest payment market share. These drugs alone accounted for US$ 787.9 million in Medicaid spending (50.8 percent of spending on antiretrovirals). Payment per prescription for each drug, with the exception of Agenerase, increased, at least somewhat, over time. The relatively expensive drugs in 2005 included Trizivir ($1040) and Combivir ($640), as well as Reyataz ($750), Lexiva ($700), Sustiva ($420), Viramune ($370), and Fuzeon ($1914). CONCLUSION The tremendous growth in antiretroviral spending is due primarily to rising utilization, secondarily to the entry of newer, more expensive antiretrovirals, and, finally, in part to rising per-prescription cost of existing medications.
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Affiliation(s)
- Yonghua Jing
- College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Patricia Klein
- College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | | | - Xing Li
- College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Jeff J Guo
- College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Institute for the Study of Health, University of Cincinnati, Cincinnati, Ohio, USA
- Professor of Pharmacoeconomics & Pharmacoepidemiology, Division of Pharmacy Practice and Administrative Sciences, University of Cincinnati College of Pharmacy, 3225 Eden Ave., Cincinnati, OH 45267-0004, USA
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Harling G, Wood R. The evolving cost of HIV in South Africa: changes in health care cost with duration on antiretroviral therapy for public sector patients. J Acquir Immune Defic Syndr 2007; 45:348-54. [PMID: 17496562 DOI: 10.1097/qai.0b013e3180691115] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. gamma-Regression was used to analyze total costs in 3 periods: Pre-ART (median length=30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs.
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Affiliation(s)
- Guy Harling
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Flaherman VJ, Porco TC, Marseille E, Royce SE. Cost-effectiveness of alternative strategies for tuberculosis screening before kindergarten entry. Pediatrics 2007; 120:90-9. [PMID: 17606566 DOI: 10.1542/peds.2006-2168] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We undertook a decision analysis to evaluate the economic and health effects and incremental cost-effectiveness of using targeted tuberculin skin testing, compared with universal screening or no screening, before kindergarten. METHODS We constructed a decision tree to determine the costs and clinical outcomes of using targeted testing compared with universal screening or no screening. Baseline estimates for input parameters were taken from the medical literature and from California health jurisdiction data. Sensitivity analyses were performed to determine plausible ranges of associated outcomes and costs. We surveyed California health jurisdictions to determine the prevalence of mandatory universal tuberculin skin testing. RESULTS In our base-case scenario, the cost to prevent an additional case of tuberculosis by using targeted testing, compared with no screening, was $524,897. The cost to prevent an additional case by using universal screening, compared with targeted testing, was $671,398. The incremental cost of preventing a case through screening remained above $100,000 unless the prevalence of tuberculin skin testing positivity increased to >10%. More than 51% of children entering kindergarten in California live where tuberculin skin testing is mandatory. CONCLUSIONS The cost to prevent a case of tuberculosis by using either universal screening or targeted testing of kindergarteners is high. If targeted testing replaced universal tuberculin skin testing in California, then $1.27 million savings per year would be generated for more cost-effective strategies to prevent tuberculosis. Improving the positive predictive value of the risk factor tool or applying it to groups with higher prevalence of latent tuberculosis would make its use more cost-effective. Universal tuberculin skin testing should be discontinued, and targeted testing should be considered only when the prevalence of risk factor positivity and the prevalence of tuberculin skin testing positivity among risk factor-positive individuals are high enough to meet acceptable thresholds for cost-effectiveness.
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Affiliation(s)
- Valerie J Flaherman
- Department of Pediatrics, University of California San Francisco, 3333 California St, San Francisco, CA 94118, USA.
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Kielar AZ, El-Maraghi RH, Carlos RC. Health-related quality of life and cost-effectiveness analysis in radiology. Acad Radiol 2007; 14:411-9. [PMID: 17368209 DOI: 10.1016/j.acra.2007.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 01/05/2007] [Accepted: 01/06/2007] [Indexed: 11/20/2022]
Affiliation(s)
- Ania Zofia Kielar
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, B2 A209, Ann Arbor, MI 48109-0030, USA.
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Llibre-Codina JM, Casado-Gómez MA, Sánchez-de la Rosa R, Pérez-Elías MJ, Santos-González J, Miralles-Alvarez C, Martínez-Chamorro E, Domingo-Pedrol P, Alvarez-García ML, Moreno-Guillén S. Costes de la toxicidad asociada a los análogos de nucleósidos inhibidores de la transcriptasa inversa en pacientes con infección por el VIH-1. Enferm Infecc Microbiol Clin 2007; 25:98-107. [PMID: 17288907 DOI: 10.1157/13098570] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To estimate the impact of toxicity related to nucleoside analogue reverse transcriptase inhibitors (NRTI) on the total cost of medical care in HIV-1-infected patients. METHODS . A pharmacoeconomic model was developed from the data obtained by a prospective, observational, multicenter study performed in Spain (Recover). The study patients had developed one NRTI-associated adverse event (AE) that justified discontinuation of treatment with the drug. All costs derived from NRTI-associated AEs in the HAART regimens of HIV-1-infected patients over a period of one year were assessed. The cost assessment (2005 values) included direct medical costs (drugs and AE management) and indirect costs (loss of productivity). The healthcare resources used in AE management were estimated by an expert panel of clinicians. RESULTS The use and cost of resources rose with increasing severity of all the AE. The average total cost per patient was estimated to be 4012 euro, which included 1789 euro in drug costs (NRTI associated with therapy discontinuation due to AE), and 2223 euro in direct and indirect costs of AE management (45% and 55% of total cost, respectively). Seventy-three per cent of AE-associated costs per patient came from lipoatrophy (560 euro), lipodystropy (535 euro) and peripheral neuropathy (533 euro). CONCLUSION Management of NRTI-related toxicities is more costly than NRTI acquisition and produces a significant increase in the overall healthcare expenditure for HIV-1-infected patients. This fact should be taken into account when designing the most efficient antiretroviral treatment strategies.
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Hellinger FJ. Economic models of antiretroviral therapy: searching for the optimal strategy. PHARMACOECONOMICS 2006; 24:631-42. [PMID: 16802839 DOI: 10.2165/00019053-200624070-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The diffusion of protease inhibitors and non-nucleoside reverse transcriptase inhibitors in the US in 1996 and 1997 reduced the number of deaths attributable to HIV disease and changed the way we think about the illness. Today, HIV disease may be deemed a fairly expensive chronic condition rather than an intolerably expensive fatal illness. Although most studies have found that patients receiving new drug therapies are hospitalised less frequently than patients who received early drug therapies, it is unclear whether the diffusion of new drug therapies has increased or decreased the annual cost of care. However, it is evident that the diffusion of new drug therapies has increased the lifetime cost of care. Analysts rely on models to simulate the course and cost of HIV disease. This study reviews the evolution of these models, paying particular attention to how these models estimate the cost of care. The primary findings of this review are that the economic data used in these models are often too imprecise to accurately identify the cost of each disease stage and are almost always outdated. Moreover, it was found that estimates of drug costs in these models may not accurately reflect actual expenditures.
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Affiliation(s)
- Fred J Hellinger
- Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality (AHRQ), Rockville, Maryland 20850, USA.
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Abstract
The Free by 5 declaration, launched in November 2004, aims to achieve free access for all individuals with HIV to a comprehensive medical package including antiretroviral treatment.
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Affiliation(s)
- Alan Whiteside
- HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban.
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Sabbatani S, Manfredi R, Biagetti C, Chiodo F. Antiretroviral Therapy in the??Real World. Clin Drug Investig 2005; 25:527-35. [PMID: 17532696 DOI: 10.2165/00044011-200525080-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE AND METHODS The aim of our study was to analyse retrospectively the nature and frequency of antiretroviral prescriptions for 990 HIV-infected patients followed at our outpatient centre in Bologna, Italy, from January 2003 to March 2004. The main focus of the study was to identify the most commonly prescribed combinations and their related expenses, in order to identify the most competitive treatment regimens with regard to costs. Prescriptions were given directly to patients at monthly intervals, and drug treatment adherence data was stored in an electronic database. Antiretroviral regimens administered for the longest period to each patient during the 15 months of the study were selected for the study. All patients treated for <9 consecutive months and/or with treatment adherence levels <90% were excluded. Physicians assessed antiretroviral therapy at least quarterly according to efficacy and safety criteria, but not in terms of pharmacoeconomic considerations. Direct pharmacy expenses were obtained for the 24 most commonly used therapeutic regimens, covering 80.1% of patients. RESULTS The zidovudine-lamivudine-efavirenz combination proved to be the most prescribed combination (7.3%), followed by zidovudine-lamivudine- nevirapine (7.1%), lamivudine-stavudine (6.2%), zidovudine-lamivudine- lopinavir-ritonavir (5.2%), didanosine-stavudine-lopinavir-ritonavir (4.8%), and lamivudine-stavudine-nevirapine (4.7%). Anti-HIV combinations varied from a minimum yearly cost of euro3895.6 for lamivudine-stavudine to euro9422.8 for the zidovudine-lamivudine-lopinavir-ritonavir combination (+241.9%) [year of costing 2003]. There was a significant difference between the two first-line regimens for antiretroviral-naive subjects, with lopinavir-ritonavir-based combinations costing more than euro9000 per patient/year compared with efavirenz-containing combinations, which were 28% less expensive. Mean daily costs varied substantially, from a minimum of euro10.7 per day for lamivudine-stavudine to a maximum of euro25.8 per day (+241.1%) for zidovudine-lamivudine-lopinavir-ritonavir. Regimens based on non-nucleoside reverse transcriptase inhibitors (NNRTIs) were less costly than most of those including protease inhibitors (PIs). The increased expense of each combination was compared with the cheapest therapeutic selection (lamivudine-stavudine), and costs of all triple combinations were also compared. Regimens based on NNRTIs accounted for 29.3% of our cohort (nevirapine-containing therapies 15.1%, and efavirenz-based ones 14.2%), while PIs were used in the majority of cases (37.3%), with lopinavir-ritonavir as the leading combination (13.6% of patients), followed by nelfinavir (9.9%) and indinavir (9.2%). When drug-related costs were examined, dual nucleoside analogues showed the lowest expense (euro10.7-euro11.6 per day), while triple nucleoside/nucleotide analogue combinations cost nearly twice as much (euro18.5-euro20.4 per day). Among the NNRTIs, there were comparable costs for nevirapine-based combinations (euro18.3-euro18.7 per day), while efavirenz-including regimens were 10% more costly (euro19.2-euro20.l per day). A very broad range of combinations and related costs were found with PIs, but apart from indinavir and saquinavir combinations (euro15.7-euro21.7 per day), all other regimens had a higher daily cost (from euro22.0 per day for ritonavir-based regimens to euro23.4-euro24.3 per day for nelfinavir combinations, and up to euro24.9-euro25.8 per day with lopinavir-ritonavir). When considering nelfinavir- and lopinavir-containing combinations, the difference compared with NNRTI-based regimens varied from 41% when nevirapine- and lopinavir-ritonavir were compared, to 11.6% when efavirenz and nelfinavir were compared. CONCLUSIONS Investigations that link prescribing patterns and related costs in the setting of HIV disease therapy are needed to improve patient management and help with the planning of healthcare resource allocation.
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Affiliation(s)
- Sergio Sabbatani
- Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna ‘Alma Mater Studiorum’, S. Orsola Hospital, Bologna, Italy
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