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Oosterhof P, Wit FWNM, van Luin M, van der Valk M, Brinkman K, Burger DM. First-line antiretroviral therapy initiation for newly diagnosed people with HIV in the Netherlands: A retrospective analysis from 2016 to 2020. PLoS One 2024; 19:e0307963. [PMID: 39058734 PMCID: PMC11280218 DOI: 10.1371/journal.pone.0307963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION HIV treating physicians in the Netherlands follow the guidelines of the Department of Health and Human Services (DHHS). Most of these recommended initial regimens are single-tablet regimens (STRs), which incur higher costs. By the end of 2017, generic NRTI backbones had become widely available, offering a potentially cheaper multi-tablet regimen. This study aimed to evaluate guideline compliance in people with HIV who started antiretroviral therapy (ART), the uptake of generic multi-tablet regimens (gMTRs), and associated medication costs. METHODS This retrospective cohort study used data from the Dutch HIV Monitoring Foundation to determine the proportion of treatment-naïve people entering care who initiated ART according to the DHHS and type of ART regimens prescribed between January 2016 and December 2020. We analyzed ART prescriptions, both at the national level and per individual HIV treatment centers. We calculated the monthly ART costs based on Dutch medicine prices listed on www.medicijnkosten.nl for each calendar year. RESULTS In 2016, an integrase inhibitor-containing regimen was initiated in 77.3% which increased to 87.8% in 2020. The compliance rate to DHHS-recommended initial regimens ranged from 82.8% in 2016 to 90.9% in 2020. Most patients received single-tablet regimens, 81.3% in 2016 to 60.3% in 2020. After the introduction the gMTRs showed a steady increase from 17.8% in 2018 to 37.8% in 2020. The cost of the first-line regimen per patient decreased by 22.9% in 2020 compared with 2017. The decrease was larger in centers where treatment-naïve individuals with HIV were preferentially initiated on a gMTR. CONCLUSIONS There was a high compliance to the "DHHS-recommended initial regimens for most people with HIV" in the Netherlands. Most people who initiated ART received STRs, although the percentage of people who started on STRs gradually decreased over time. The use of gMTRs increased over time and was associated with lower medication costs.
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Affiliation(s)
- Piter Oosterhof
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, the Netherlands
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ferdinand W. N. M. Wit
- Division of Infectious Diseases, Amsterdam University Medical Centers, Location Academic Medical Center, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Matthijs van Luin
- Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, the Netherlands
| | - Marc van der Valk
- Division of Infectious Diseases, Amsterdam University Medical Centers, Location Academic Medical Center, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Kees Brinkman
- Division of Infectious Diseases, Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - David M. Burger
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, The Netherlands
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Cousien A, Donadille C, Madrid LB, Maradan G, Jauffret-Roustide M, Lalanne L, Auriacombe M, Roux P, Boyer S. Cost-effectiveness of drug consumption rooms in France: a modelling study. BMC Public Health 2024; 24:1426. [PMID: 38807111 PMCID: PMC11135012 DOI: 10.1186/s12889-024-18909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) experience many health problems which result in a heavy economic and public health burden. To tackle this issue, France opened two drug consumption rooms (DCRs) in Paris and Strasbourg in 2016. This study assessed their long-term health benefits, costs and cost-effectiveness. METHODS We developed a model to simulate two fictive cohorts for each city (n=2,997 in Paris and n=2,971 in Strasbourg) i) PWID attending a DCR over the period 2016-2026, ii) PWID attending no DCR. The model accounted for HIV and HCV infections, skin abscesses and related infective endocarditis, drug overdoses and emergency department visits. We estimated the number of health events and associated costs over 2016-2026, the lifetime number of quality-adjusted life-years (QALYs) and costs, and the incremental cost-effectiveness ratio (ICER). RESULTS The numbers of abscesses and associated infective endocarditis, drug overdoses, and emergency department visits decreased significantly in PWID attending DCRs (-77%, -69%, and -65%, respectively) but the impact on HIV and HCV infections was modest (-11% and -6%, respectively). This resulted in savings of €6.6 (Paris) and €5.8 (Strasbourg) millions of medical costs. The ICER of DRCs was €30,600/QALY (Paris) and €9,200/QALY (Strasbourg). In scenario analysis where drug consumption spaces are implemented inside existing harm reduction structures, these ICERs decreased to €21,400/QALY and €2,500/QALY, respectively. CONCLUSIONS Our findings show that DCRs are highly effective and efficient to prevent harms in PWID in France, and advocate extending this intervention to other cities by adding drug consumption spaces inside existing harm reduction centers.
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Affiliation(s)
- Anthony Cousien
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018, Paris, France.
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Cécile Donadille
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Gwenaëlle Maradan
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Jauffret-Roustide
- Centre d'Etudes des Mouvements Sociaux, Inserm U1276, CNRS UMR 8044, EHESS, Paris, France
- British Columbia Center on Substance Use (BCCSU), Vancouver, Canada
- Baldy Center on Law and Social Policy, Buffalo University, New York, USA
- Institut universitaire sur les dépendances, Université de Sherbrooke, Montréal, Québec, Canada
| | - Laurence Lalanne
- UMR 1329, Team Addictions, Centre de recherche en biomédecine de Strasbourg, Department of addiction medicine, University hospital of Strasbourg, Strasbourg, France
| | - Marc Auriacombe
- UMR 6033, Bordeaux University, SANPSY, CNRS, Bordeaux, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Sylvie Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Oosterhof P, de Zoete BGJA, Vanhommerig JW, Langebeek N, Gisolf EH, van Hulzen AGW, Lammers AJJ, Weijsenfeld AM, van der Valk M, Grintjes K, van Crevel R, van Luin M, Brinkman K, Burger DM. De-simplifying antiretroviral therapy from a single-tablet to a two-tablet regimen: Acceptance, patient-reported outcomes, and cost savings in a multicentre study. HIV Med 2024. [PMID: 38712697 DOI: 10.1111/hiv.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Antiretroviral therapy (ART), which is increasingly used by people with HIV, accounts for significant care costs, particularly because of single-tablet regimens (STRs). This study explored de-simplification to a two-tablet regimen (TTR) for cost reduction. The objectives of this study were: (1) acceptance of de-simplification, (2) patient-reported outcomes, and (3) cost savings. METHODS All individuals on Triumeq®, Atripla® or Eviplera® in five HIV clinics in the Netherlands were eligible. Healthcare providers informed individuals of this study. After inclusion, individuals were free to de-simplify. An electronic questionnaire was sent to assess study acceptance, adherence, quality of life (SF12) and treatment satisfaction (HIVTSQ). After 3 and 12 months, questionnaires were repeated. Cost savings were calculated using Dutch drug prices. RESULTS In total, 283 individuals were included, of whom 55.5% agreed to de-simplify their ART, with a large variability between treatment centres: 41.1-74.2%. Individuals who were willing to de-simplify tended to be older, had a longer history of HIV diagnosis, and used more co-medication than those who preferred to remain on an STR regimen. Patient-reported outcomes, including quality of life and treatment satisfaction, showed no significant difference between people with HIV who switched to a TTR and those who remained on an STR regimen. Furthermore, we observed a 17.8% reduction in drug costs in our cohort of people with HIV who were initially on an STR. CONCLUSIONS De-simplification from an STR to a TTR within the Dutch healthcare setting has been demonstrated as feasible, leads to significant cost reductions and should be discussed with every eligible person with HIV in the Netherlands.
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Affiliation(s)
- P Oosterhof
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B G J A de Zoete
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - J W Vanhommerig
- Department of Research and Epidemiology, OLVG Hospital, Amsterdam, The Netherlands
| | - N Langebeek
- Department of Internal Medicine and Infectious Diseases, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - E H Gisolf
- Department of Internal Medicine and Infectious Diseases, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - A G W van Hulzen
- Department of Internal Medicine, Division of Infectious Diseases, Isala Clinics, Zwolle, The Netherlands
| | - A J J Lammers
- Department of Internal Medicine, Division of Infectious Diseases, Isala Clinics, Zwolle, The Netherlands
| | - A M Weijsenfeld
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - M van der Valk
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - K Grintjes
- Department of Internal Medicine, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R van Crevel
- Department of Internal Medicine, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M van Luin
- Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, The Netherlands
| | - K Brinkman
- Department of Internal Medicine, Division of Infectious Diseases, OLVG, Amsterdam, The Netherlands
| | - D M Burger
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Centre, Nijmegen, The Netherlands
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Marinosci A, Sculier D, Wandeler G, Yerly S, Stoeckle M, Bernasconi E, Braun DL, Vernazza P, Cavassini M, Buzzi M, Metzner KJ, Decosterd L, Günthard HF, Schmid P, Limacher A, Branca M, Calmy A. Costs and acceptability of simplified monitoring in HIV-suppressed patients switching to dual therapy: the SIMPL'HIV open-label, factorial randomised controlled trial. Swiss Med Wkly 2024; 154:3762. [PMID: 38754068 DOI: 10.57187/s.3762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Clinical and laboratory monitoring of patients on antiretroviral therapy is an integral part of HIV care and determines whether treatment needs enhanced adherence or modification of the drug regimen. However, different monitoring and treatment strategies carry different costs and health consequences. MATERIALS AND METHODS The SIMPL'HIV study was a randomised trial that assessed the non-inferiority of dual maintenance therapy. The co-primary outcome was a comparison of costs over 48 weeks of dual therapy with standard antiretroviral therapy and the costs associated with a simplified HIV care approach (patient-centred monitoring [PCM]) versus standard, tri-monthly routine monitoring. Costs included outpatient medical consultations (HIV/non-HIV consultations), non-medical consultations, antiretroviral therapy, laboratory tests and hospitalisation costs. PCM participants had restricted immunological and blood safety monitoring at weeks 0 and 48, and they were offered the choice to complete their remaining study visits via a telephone call, have medications delivered to a specified address, and to have blood tests performed at a location of their choice. We analysed the costs of both strategies using invoices for medical consultations issued by the hospital where the patient was followed, as well as those obtained from health insurance companies. Secondary outcomes included differences between monitoring arms for renal function, lipids and glucose values, and weight over 48 weeks. Patient satisfaction with treatment and monitoring was also assessed using visual analogue scales. RESULTS Of 93 participants randomised to dolutegravir plus emtricitabine and 94 individuals to combination antiretroviral therapy (median nadir CD4 count, 246 cells/mm3; median age, 48 years; female, 17%),patient-centred monitoring generated no substantial reductions or increases in total costs (US$ -421 per year [95% CI -2292 to 1451]; p = 0.658). However, dual therapy was significantly less expensive (US$ -2620.4 [95% CI -2864.3 to -2331.4]) compared to standard triple-drug antiretroviral therapy costs. Approximately 50% of participants selected one monitoring option, one-third chose two, and a few opted for three. The preferred option was telephone calls, followed by drug delivery. The number of additional visits outside the study schedule did not differ by type of monitoring. Patient satisfaction related to treatment and monitoring was high at baseline, with no significant increase at week 48. CONCLUSIONS Patient-centred monitoring did not reduce costs compared to standard monitoring in individuals switching to dual therapy or those continuing combined antiretroviral therapy. In this representative sample of patients with suppressed HIV, antiretroviral therapy was the primary factor driving costs, which may be reduced by using generic drugs to mitigate the high cost of lifelong HIV treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT03160105.
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Affiliation(s)
- Annalisa Marinosci
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Delphine Sculier
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, and the University of Geneva Faculty of Medicine, Geneva, Switzerland
- Private Practice Office, Geneva, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sabine Yerly
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Enos Bernasconi
- Service of Infectious Diseases, Lugano Regional Hospital, Lugano, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Kantonspital St.Gallen, St. Gall, Switzerland
| | - Matthias Cavassini
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marta Buzzi
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, and the University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Karin J Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Laurent Decosterd
- Pharmacology Laboratory, Clinical Pharmacology Department, University of Lausanne, Lausanne, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Kantonspital St.Gallen, St. Gall, Switzerland
| | | | | | - Alexandra Calmy
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, and the University of Geneva Faculty of Medicine, Geneva, Switzerland
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Castry M, Cousien A, Champenois K, Supervie V, Velter A, Ghosn J, Yazdanpanah Y, Paltiel AD, Deuffic‐Burban S. Cost-effectiveness of hepatitis C virus test-and-treat and risk reduction strategies among men who have sex with men living with HIV in France. J Int AIDS Soc 2022; 25:e26035. [PMID: 36451286 PMCID: PMC9712801 DOI: 10.1002/jia2.26035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Studies suggest that hepatitis C virus (HCV) micro-elimination is feasible among men who have sex with men (MSM) living with human immunodeficiency virus (HIV), through treatment-as-prevention and interventions aimed at reducing risk behaviours. However, their economic impact is poorly understood. The aim of this study was to assess the cost-effectiveness of HCV screening and risk reduction strategies in France. METHODS A compartmental deterministic mathematical model was developed to describe HCV disease transmission and progression among MSM living with HIV in France. We evaluated different combinations of HCV screening frequency (every 12, 6 or 3 months) and risk reduction strategies (targeting only high-risk or all MSM) from 2021 onwards. The model simulated the number of HCV infections, life-expectancy (LYs), quality-adjusted life-expectancy (QALYs), lifetime costs and incremental cost-effectiveness ratio (ICER) over a lifetime horizon (leading to an end of the simulation in 2065). RESULTS All strategies increased QALYs, compared with current practices, that is yearly HCV screening, with no risk reduction. A behavioural intervention resulting in a 20% risk reduction in the high-risk group, together with yearly screening, was the least expensive strategy, and, therefore, cost-saving compared to current practices. The ICER per QALY gained for the strategy combining risk reduction for the high-risk group with 6-month HCV screening, compared to risk reduction with yearly screening, was €61,389. It also prevented 398 new HCV infections between 2021 and 2065, with a cost per infection averted of €37,790. All other strategies were dominated (more expensive and less effective than some other available alternative) or not cost-effective (ICER per QALY gained > €100,000). CONCLUSIONS In the French context, current HCV screening practices without risk reduction among MSM living with HIV cannot be justified on economic grounds. Risk reduction interventions targeted to high-risk individuals-alongside screening either once or twice a year-could be cost-effective depending on the policymaker's willingness-to-pay.
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Affiliation(s)
| | | | | | - Virginie Supervie
- Sorbonne UniversitéInsermInstitut Pierre Louis d’Épidémiologie et de Santé PubliqueParisFrance
| | | | - Jade Ghosn
- Université de ParisIAMEINSERMParisFrance,Service de maladies Infectieuses et tropicalesHôpital Bichat Claude BernardParisFrance
| | - Yazdan Yazdanpanah
- Université de ParisIAMEINSERMParisFrance,Service de maladies Infectieuses et tropicalesHôpital Bichat Claude BernardParisFrance
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Rom T, Levy I, Perlman S, Ziv-Baran T, Mor O. Determinants of Direct Costs of HIV-1 Outpatient Care in Israel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14542. [PMID: 36361428 PMCID: PMC9655323 DOI: 10.3390/ijerph192114542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
HIV-1 patients place an economic burden on the health system. The objectives of this study were to estimate the direct HIV-1 costs and cost-related factors of HIV-1 patients in Israel and identify cost predictors. We conducted a retrospective study of randomly selected HIV-1 patients aged ≥18 who visited a large outpatient clinic in 2015 and/or 2019. Yearly costs of physician and nurse visits, antiretroviral therapy (ART) and laboratory tests were calculated in USD using the 2020 purchasing power parities. Associations between disease characteristics and costs were analyzed using univariate and multivariable analysis. The median (IQR) total direct costs per patient per year were USD 12,387 (9813-14,124) and USD 12,835 (11,651-13,970) in 2015 (n = 284) and 2019 (n = 290), respectively. ART accounted for approximately 77% of all direct costs, followed by laboratory tests (20%) and medical visits (3%) in both studied years. Being female (USD +710), first yearly viral load <50 c/mL (+$1984) and ≥20 years with HIV-1 (USD +1056) were independently associated with higher costs. In conclusion, HIV-1 cost was stable in the studied period. Viral load and time since diagnosis were the major determinants associated with HIV-1 costs. ART and laboratory tests accounted for 97% of the costs. Therefore, these factors should be considered when planning future expenditures.
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Affiliation(s)
- Tom Rom
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Itzchak Levy
- Infectious Disease Unit, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 61390, Israel
| | - Saritte Perlman
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Orna Mor
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- National HIV-1 and Viral Hepatitis Reference Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
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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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8
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Prodel M, Finkielsztejn L, Roustand L, Nachbaur G, De Leotoing L, Genreau M, Bonnet F, Ghosn J. Costs and mortality associated with HIV: a machine learning analysis of the French national health insurance database. J Public Health Res 2021; 11. [PMID: 34850620 PMCID: PMC8958442 DOI: 10.4081/jphr.2021.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The objective is to characterise the economic burden to the healthcare system of people living with HIV (PLWHIV) in France and to help decision makers in identifying risk factors associated with high-cost and high mortality profiles. Design and methods: The study is a retrospective analysis of PLWHIV identified in the French National Health Insurance database (SNDS). All PLWHIV present in the database in 2013 were identified. All healthcare resource consumption from 2008 to 2015 inclusive was documented and costed (for 2013 to 2015) from the perspective of public health insurance. High-cost and high mortality patient profiles were identified by a machine learning algorithm. Results: In 2013, 96,423 PLWHIV were identified in the SNDS database, including 3,373 incident cases. Overall, 3,224 PLWHIV died during the three-year follow-up period (mean annual mortality rate: 1.1%). The mean annual per capita cost incurred by PLWHIV was € 14,223, corresponding to a total management cost of HIV of € 1,370 million in 2013. The largest contribution came from the cost of antiretroviral medication (M€ 870; 63%) followed by hospitalisation (M€ 154; 11%). The costs incurred in the year preceding death were considerably higher. Four specific patient profiles were identified for under/over-expressing these costs, suggesting ways to reduce them. Conclusions: Even though current therapeutic regimens provide excellent virological control in most patients, PLWHIV have excess mortality. Other factors such as comorbidities, lifestyle factors and screening for cancer and cardiovascular disease, need to be targeted in order to lower the mortality and cost associated with HIV infection. Significance for public health The authors believe that this study is important in that it provides for the first time an estimate of the most impacting factors of the total economic burden of HIV infections to public health insurance in France. The approach relies on a state of-the-art machine learning analysis. Regarding epidemiological results, although the prevalence and incidence of HIV infections in Western European countries are reasonably well documented, there is a paucity of information on its economic burden. We suggest ways that the economic burden of HIV (€ 1,400 million annually to public health insurance), as well as associated mortality, could be reduced. The main interest and novelty of the results from a public health perspective is the identification of patient profiles at risk of high costs. Such results provide clear and potentially actionable levers to decision makers, either for prevention plans, for patient pathways, or for reimbursement strategies.
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Affiliation(s)
| | | | | | | | | | | | - Fabrice Bonnet
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux; Université de Bordeaux, INSERM U1219, ISPED, Bordeaux.
| | - Jade Ghosn
- Assistance Publique - Hôpitaux de Paris, APHP; Nord-Université de Paris, Hôpital Bichat-Claude-Bernard, Service des Maladies Infectieuses et Tropicales, Paris.
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Papot E, Kalampalikis N, Doumergue M, Pilorgé F, Quatremère G, Yazdanpanah Y, Préau M. Can we talk about price with patients when choosing antiretroviral therapy? A survey with people living with HIV and prescribers in France. BMJ Open 2021; 11:e046212. [PMID: 34836895 PMCID: PMC8628338 DOI: 10.1136/bmjopen-2020-046212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate people living with HIV (PLWH) and HIV specialist prescribers' perception of discussing antiretroviral therapy (ART) price in PLWH's care and the acceptability of choosing or switching to various types of less expensive ARTs. DESIGN Cross-sectional surveys (one in a convenience sample of PLWH and one in a voluntary response sample of HIV specialist prescribers). SETTING AND PARTICIPANTS The surveys were conducted among PLHW attending an HIV clinic in the North of Paris (cohort of 4922 PLWH in 2016), and HIV specialists working in French HIV clinics (210 across 12 districts/28), between January and June 2016. METHOD Self-administered questionnaires were constructed using data collected during focus groups with PLWH and prescribers. Pretests were carried out to select the questions and items. Descriptive analyses of the 129 complete questionnaires of PLWH and 79 of prescribers are presented. RESULTS Among PLWH, 128/129 were on ART and 54% (69/128) gave a fair estimation of the price of their current regimen. Among prescribers, 24% (19/79) thought that their patients knew this price. Taking into account the price of ART was not perceived as a negative step in the history of French response to HIV epidemic for 53% (68/129) of PLWH and 82% (65/79) of prescribers. Seventy-seven PLWH (60%) would agree to switch to less expensive antiretroviral regimens (as effective and with similar adverse events) if pills were bigger; 42 (33%) if there were more daily doses, and 37 (29%) if there were more pills per dose; prescribers were more circumspect. CONCLUSION A high proportion of PLWH gave a fair estimate of their ART price and this seemed unexpected by HIV specialists. Consideration of drug prices when choosing ART was perceived as conceivable by PLWH and prescribers if effectiveness and tolerance were also considered.
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Affiliation(s)
- Emmanuelle Papot
- Université de Paris, INSERM, IAME, F-75006, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, F-75018 Paris, France
| | | | | | | | | | - Yazdan Yazdanpanah
- Université de Paris, INSERM, IAME, F-75006, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, F-75018 Paris, France
| | - Marie Préau
- UMR 1296 « Radiations : Défense, Santé, Environnement », Université Lumière Lyon 2, Institut de Psychologie, Bron, France
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Suárez‐García I, Alejos B, Ruiz‐Algueró M, García Yubero C, Moreno C, Bernal E, Pérez‐Is L, Zubero Z, de Zárraga Fernández MA, Samperiz Abad G, Jarrín I. Effectiveness and tolerability of dolutegravir and abacavir/lamivudine administered as two separate pills compared to their equivalent single-tablet regimen in a multicentre cohort in Spain. J Int AIDS Soc 2021; 24:e25758. [PMID: 34291580 PMCID: PMC8295592 DOI: 10.1002/jia2.25758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION We aimed to assess the effectiveness and tolerability of dolutegravir (DTG), abacavir (ABC) and lamivudine (3TC) administered as branded STR (DTG/ABC/3TC) or as two separate pills (DTG and either branded ABC/3TC [DTG+(ABC/3TC)b] or generic ABC/3TC [DTG+(ABC/3TC)g]). METHODS We included individuals from the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) who received DTG/ABC/3TC, DTG+(ABC/3TC)b or DTG+(ABC/3TC)g during 2015 to 2018. We used multivariable logistic regression to compare the proportion of antiretroviral-naïve individuals who achieved viral suppression (VS) (viral load ≤50 copies/mL) at 24 weeks of initiating with DTG+(ABC/3TC)b or DTG+(ABC/3TC)g versus DTG/ABC/3TC. We also calculated the proportion of virologically suppressed individuals who maintained VS at 24 weeks after switching from DTG/ABC/3TC to DTG+(ABC/3TC)g. RESULTS During the study period, 829, 68 and 47 treatment-naïve individuals started treatment with DTG/ABC/3TC, DTG+(ABC/3TC)b or DTG+(ABC/3TC)g respectively. The proportions of individuals who changed their regimens due to side effects during the first 24 weeks were 3.7%, 4.4% and 6.4% respectively (p = 0.646). We did not find significant differences in VS at 24 weeks among individuals starting with DTG+(ABC/3TC)b or DTG+(ABC/3TC)g compared to those initiating with DTG/ABC/3TC. Among 177 virologically suppressed individuals who switched from DTG/ABC/3TC to DTG+(ABC/3TC)g, 170 (96.0%) maintained VS at 24 weeks. CONCLUSIONS In naïve individuals, the effectiveness and tolerability at 24 weeks of DTG plus ABC/3TC administered as two separate pills, either as branded or generic ABC/3TC, was similar to the STR DTG/ABC/3TC. Switching the STR DTG/ABC/3TC to its separate components DTG+(ABC/3TC)g in virologically suppressed individuals did not seem to impair its effectiveness.
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Affiliation(s)
- Inés Suárez‐García
- Infectious Diseases GroupDepartment of Internal MedicineHospital Universitario Infanta Sofía (FIIB HUIS HHEN)MadridSpain
- Universidad EuropeaMadridSpain
| | - Belén Alejos
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
| | | | - Cristina García Yubero
- Department of Hospital PharmacyHospital Universitario Infanta Sofía (FIIB HUIS HHEN)MadridSpain
| | - Cristina Moreno
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
| | - Enrique Bernal
- Infectious Diseases SectionHospital General Universitario Reina SofíaMurciaSpain
| | - Laura Pérez‐Is
- FINBA/ISPAHospital Universitario Central de AsturiasAvilésSpain
| | - Zuriñe Zubero
- Department of Infectious Diseases. HospitalUniversitario BasurtoBizkaiaSpain
| | | | | | - Inma Jarrín
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
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Giraud JS, Doisne M, Chan Hew Wai A, Majerholc C, Fourn E, Sejean K, Trichereau J, Bonan B, Zucman D. De-simplifying single-tablet antiretroviral treatments for cost savings in France: From the patient perspectives to a 6-month follow-up on generics. PLoS One 2020; 15:e0239704. [PMID: 32976493 PMCID: PMC7518587 DOI: 10.1371/journal.pone.0239704] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/13/2020] [Indexed: 11/19/2022] Open
Abstract
In developed countries, most people living with HIV/AIDS are treated with costly brand single-tablet regimens. Given the economic impact, French guidelines recommend using generic antiretroviral therapy when possible to decrease antiretroviral therapy costs. We aimed to study HIV-infected patients’ acceptability to switch from a brand single-tablet regimens [abacavir/lamivudine/dolutegravir (Triumeq®) or emtricitabine/tenofovir disoproxil fumarate/rilpivirine (Eviplera®)] to a treatment comprising of two pills: one is a fixed-dose generic combination of 2 Nucleoside Analogs and the second tablet is the third antiretroviral. This study was a prospective observational study in a French hospital. During their follow-up, patients on stable single-tablet regimens were made aware of the possible cost-saving. They were questioned about their willingness and barriers accepting the substitution. Participants chose between the two regimens, either to remain on single-tablet regimens or switch to the de-simplified regimen. Six months later, a second survey was given to the patient who chose to de-simplify and HIV viral load was controlled. The study included 98 patients: 60 receiving emtricitabine/tenofovir disoproxil fumarate/rilpivirine (Eviplera®) and 38 on abacavir/lamivudine/dolutegravir (Triumeq®). Forty-five patients accepted the de-simplified treatment, 37 refused and 16 were undecided and followed the decision offered by their physician. The main reason for unwillingness to switch is the number of pills (77.3%). In multivariate model analysis, male patients (p = 0.001) who have taken antiretroviral therapy for over 20 years (p = 0.04) and who retrieve their treatment in their community hospital (p = 0.03) are more likely to accept the switch. Fifty-one patients accepted to replace their single-tablet regimens and six months later, the majority was satisfied; only four returned to single-tablet regimens because of suspected side effects. Half of the people living with HIV/AIDS in our cohort accepted to switch from brand single-tablet regimens to a two-tablet regimen containing generic drugs within a process that emphasizes health expenditure savings.
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Affiliation(s)
| | | | | | | | - Erwan Fourn
- HIV Department, Foch Hospital, Suresnes, France
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Krentz H, Campbell S, Gill J. Desimplification of Single Tablet Antiretroviral (ART) Regimens-A Practical Cost-Savings Strategy? J Int Assoc Provid AIDS Care 2020; 18:2325958218822304. [PMID: 30672364 PMCID: PMC6748513 DOI: 10.1177/2325958218822304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The use of lifelong antiretroviral therapy (ART) results in increased costs of care; the ability to finance and control sustained costs of ART needs to be discussed. APPROACH The Southern Alberta Clinic initiated a practical cost savings approach that switched select patients from a branded ART to a less expensive generic variation. Our approach surveyed physicians and patients on their acceptance of switching and then launched a program asking patients if they would switch to generic variations for cost control purposes. RESULTS Our early findings found >50% of patients approached agreed to switch. We found no evidence of increased risk of viral breakthrough, resistance, side effects, or displeasure with generic drugs. Measured cost savings in the first year were >$1.1 million with annual projected savings of between $4.3 million and $2.6 million (in 2017 Cdn$). CONCLUSION Our approach can provide an option for controlling costs of HIV care without compromising quality.
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Affiliation(s)
- Hartmut Krentz
- 1 Southern Alberta Clinic, Calgary, Canada.,2 Department of Medicine, University of Calgary, Calgary, Canada
| | | | - John Gill
- 1 Southern Alberta Clinic, Calgary, Canada.,2 Department of Medicine, University of Calgary, Calgary, Canada
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Leon-Reyes S, Schäfer J, Früh M, Schwenkglenks M, Reich O, Schmidlin K, Staehelin C, Battegay M, Cavassini M, Hasse B, Bernasconi E, Calmy A, Hoffmann M, Schoeni-Affolter F, Zhao H, Bucher HC. Cost Estimates for Human Immunodeficiency Virus (HIV) Care and Patient Characteristics for Health Resource Use From Linkage of Claims Data With the Swiss HIV Cohort Study. Clin Infect Dis 2020; 68:827-833. [PMID: 30020416 DOI: 10.1093/cid/ciy564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Comprehensive and representative data on resource use are critical for health policy decision making but often lacking for human immunodeficiency virus (HIV) infection. Privacy-preserving probabilistic record linkage of claim and cohort study data may overcome these limitations. METHODS Encrypted dates of birth, sex, study center, and antiretroviral therapy (ART) from the Swiss HIV Cohort Study (SHCS) records for 2012 and 2013 were linked by privacy-preserving probabilistic record linkage with claim data from the largest health insurer covering 15% of the Swiss residential population. We modeled predictors for mean annual costs adjusting for censoring and grouped patients by cluster analysis into 3 risk groups for resource use. RESULTS The matched subsample of 1196 patients from 9326 SHCS and 2355 claim records was representative for all SHCS patients receiving ART. The corrected mean (standard error) total costs in 2012 and 2013 were $30462 ($582) and $30965 ($629) and mainly accrued in ambulatory care for ART (70% of mean costs). The low-risk group for resource use had mean (standard error) annual costs of $26772 ($536) and $26132 ($589) in 2012 and 2013. In the moderate- and high-risk groups, annual costs for 2012 and 2013 were higher by $3526 (95% confidence interval, $1907-$5144) (13%) and $4327 ($2662-$5992) (17%) and $14026 ($8763-$19289) (52%) and $13567 ($8844-$18288) (52%), respectively. CONCLUSIONS In a representative subsample of patients from linkage of SHCS and claim data, ART was the major cost factor, but patient profiling enabled identification of factors related to higher resource use.
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Affiliation(s)
- Selene Leon-Reyes
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel
| | - Juliane Schäfer
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel
| | - Mathias Früh
- Department of Health Sciences, Helsana-Group Zurich, Switzerland
| | | | - Oliver Reich
- Department of Health Sciences, Helsana-Group Zurich, Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Cornelia Staehelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Basel and University of Basel, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne (CHUV), Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Hygiene, University Hospital and University of Zurich, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | - Matthias Hoffmann
- Division of Infectious Diseases, Kantonsspital St. Gallen, Switzerland
| | | | - Hongwei Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel.,Division of Infectious Diseases and Hospital Epidemiology University Hospital Basel and University of Basel, Switzerland
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Kinghorn A. Using information on ART costs and benefits to mobilise resources - comparing different methods and contexts. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 18:289-296. [PMID: 31779574 DOI: 10.2989/16085906.2019.1688363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sustaining HIV and AIDS responses depends on a mix of donor, government and private funders. Their decisions about investing in HIV treatment may be informed by various types of economic evaluations, which may be more or less useful for different contexts. This paper benchmarks methods against each other. Epidemiological and demographic impacts of HIV and antiretroviral therapy (ART) from 1996-2015 were quantified using country- specific spectrum files. The study compared societal benefits of ART using the full income (FI) methodology with "conventional" benefit, utility and effectiveness estimates produced with the same data. The FI estimates suggested $3.50 in benefits per dollar spent on ART globally, 2.6 times larger than productivity-related measures of benefits, of $1.33 in benefits per dollar. Higher benefit-cost ratios are mainly because FI reflects value of life beyond what people produce at work and in non-working age groups, and allocates the future stream of benefits in the year that death is avoided. ART costs were 0.78 times per capita GDP per quality-adjusted life-years gained globally. FI benefit-cost ratios are considerably higher in upper- and lower-middle-income countries than in low- or high-income countries. Productivity-based benefits also exceeded costs in all but one region but had smaller ratios and different regional patterns. Per capita GDP per quality-adjusted life-years ratios were below 1.2 for all regions and country income bands, suggesting cost effectiveness. The fact that FI returns of ART are higher than productivity returns, helps to quantify developmental benefits of interventions that directly extend life and its quality, arguably the objective of development. They provide an important argument to increase budget allocations to health sectors for ART scale-up, and not just reallocate existing health resources. Benchmarking FI returns against cost per quality- adjusted life-years may allow comparison to other "cost effective" health interventions. However, caution should be taken in extrapolations between measures, because they produce different rankings across country categories.
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Affiliation(s)
- Anthony Kinghorn
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
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15
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Krentz HB, Vu Q, Gill MJ. Updated direct costs of medical care for HIV‐infected patients within a regional population from 2006 to 2017. HIV Med 2019; 21:289-298. [DOI: 10.1111/hiv.12824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
Affiliation(s)
- HB Krentz
- Southern Alberta Clinic Calgary AB Canada
- Department of Medicine University of Calgary Calgary AB Canada
| | - Q Vu
- Southern Alberta Clinic Calgary AB Canada
| | - MJ Gill
- Southern Alberta Clinic Calgary AB Canada
- Department of Medicine University of Calgary Calgary AB Canada
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Garay OU, Nishimwe ML, Bousmah MAQ, Janah A, Girard PM, Chêne G, Moinot L, Sagaon-Teyssier L, Meynard JL, Spire B, Boyer S. Cost-Effectiveness Analysis of Lopinavir/Ritonavir Monotherapy Versus Standard Combination Antiretroviral Therapy in HIV-1 Infected Patients with Viral Suppression in France (ANRS 140 DREAM). PHARMACOECONOMICS - OPEN 2019; 3:505-515. [PMID: 30968368 PMCID: PMC6861410 DOI: 10.1007/s41669-019-0130-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Protease inhibitor monotherapy is a simplified treatment strategy for virally suppressed HIV-positive patients that has the potential for cost savings, as fewer drugs are used than with combination therapy. However, evidence for its economic value is limited. OBJECTIVES We assessed the cost-effectiveness of lopinavir/ritonavir monotherapy followed by treatment intensification in case of viral load rebound versus combination antiretroviral therapy (cART) with efavirenz/emtricitabine/tenofovir in HIV-1 infected patients with viral suppression in the ANRS 140 DREAM trial. METHODS DREAM was conducted in 36 French Hospitals between 2009 and 2013. For each treatment strategy, we estimated the unadjusted and multivariate-adjusted mean costs (in €, year 2010 values) and quality-adjusted life-years (QALYs) per patient, as well as incremental costs and QALYs per patient. We then assessed uncertainty using the cost-effectiveness acceptability curve, scenario analyses and cost-effectiveness price-threshold (CEPT) analysis. RESULTS In the base-case analysis considering 2009-2013 antiretroviral drug (ARV) prices, adjusted incremental costs and QALYs were - €3296 (95% confidence interval [CI] - 5202 to - 1391) and 0.006 (95% CI - 0.021 to 0.033), respectively, over 2 years, suggesting that monotherapy was cost-effective with a probability of 100% at various cost-effectiveness thresholds. In scenario analyses considering 2018 ARV prices, monotherapy remained cost-effective but with a lower probability (94% vs. 100% in the base-case analysis). The current price of cART would have to decrease by 34% to be cost-effective with a probability of 95%. CONCLUSION Monotherapy appears to be cost-effective compared with cART for virologically suppressed HIV-positive patients in France. CEPT analysis is a useful tool to identify the preferred strategy to adopt given that ARV prices change rapidly. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT00946595.
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Affiliation(s)
- Osvaldo Ulises Garay
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | - Marie Libérée Nishimwe
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | - Marwân-Al-Qays Bousmah
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Asmaa Janah
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | | | - Geneviève Chêne
- INSERM Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, ISPED, 33000, Bordeaux, France
- CHU Bordeaux, Division of Public Health, 33000, Bordeaux, France
| | - Laetitia Moinot
- INSERM Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, ISPED, 33000, Bordeaux, France
| | - Luis Sagaon-Teyssier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | - Sylvie Boyer
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de l'Information Médicale, Aix Marseille University, Marseille, France.
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Heterogeneity in the costs of medical care among people living with HIV/AIDS in the United States. AIDS 2019; 33:1491-1500. [PMID: 30950881 DOI: 10.1097/qad.0000000000002220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The costs of medical care for people with HIV/AIDS (PWH) vary substantially across demographic groups, stages of disease progression and regionally across the United States. We aimed to estimate medical costs for PWH and examine the heterogeneity in costs within key patient groups typically distinguished in cost-effectiveness analyses. DESIGN Retrospective cohort study using health administrative databases for diagnosed PWH in care at 17 HIV Research Network sites across the United States. METHODS We estimated mean quarterly costs for key patient groups using multivariable generalized linear mixed effects models. We used quantile regression to highlight differences in the effect of covariates within each patient group (difference between covariate estimates at the mean versus the 90th percentile of quarterly costs), identifying covariates with a larger effect among the highest cost PWH, or generating greater uncertainty in mean cost estimates. RESULTS Our sample included 40 022 patients with a median age of 39 years. Mean quarterly costs were highest for people who inject drugs with advanced disease progression and for PWH on antiretroviral treatment (ART). Within patient groups, we found the most heterogeneity at different levels of resource use for PWH on ART and PWH off ART with CD4 cell counts less than 200 cells/μl, people who inject drugs, as well as PWH in the South. CONCLUSION The study quantifies heterogeneity in costs both across and within key PWH patient groups. Our results highlight the need for sensitivity analysis on cost estimates and may inform decisions on model structure in cost-effectiveness analyses on HIV/AIDS treatment and prevention strategies.
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Prevalence and related drug cost of comorbidities in HIV-infected patients receiving highly active antiretroviral therapy in Taiwan: A cross-sectional study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:720-727. [PMID: 31358463 DOI: 10.1016/j.jmii.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/09/2019] [Accepted: 05/29/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND To determine the prevalence of chronic comorbidities and associated medication costs in Taiwanese HIV patients in order to increase awareness of the disease burden among healthcare providers and patients. METHODS HIV-diagnosed patients receiving highly active antiretroviral therapy (HAART; 2010-2013) were identified from the Taiwan National Health Insurance Research Database with the corresponding International Classification of Diseases, ninth revision (ICD-9) code. Comorbidities (type II diabetes mellitus, hypertension, dyslipidemia, major depressive disorder, acute coronary syndrome, and cholelithiasis/nephrolithiasis) were identified according to ICD-9 or relevant medication use. Comorbidity medication and associated costs were identified using the drug classification code from the Anatomical Therapeutic Chemical classification system code series and series outpatient prescriptions. RESULTS Of 20,726 HIV-diagnosed Taiwanese patients (2010-2013), 13,142 receiving HAART were analyzed. Prevalence of all chronic comorbidities was significantly greater (p < 0.0001) in patients aged ≥40 years versus <40 years (diabetes mellitus, 14.95% vs. 3.30%; hypertension, 46.73% vs. 26.83%; dyslipidemia, 34.93% vs. 18.37%; depression, 23.75% vs. 19.88%; acute coronary syndrome, 1.16% vs. 0.21%; nephrolithiasis/cholelithiasis, 7.26% vs. 4.56%; >2 comorbidities, 24.80% vs. 7.21%). An increase in comorbidity medication spending (2010 vs. 2013 medication costs) was observed (antidyslipidemia, $88,878 vs. $168,180; antihyperglycemia, $32,372 vs. $73,518; antidepressants, $78,220 vs. $125,971; sedatives, $60,009 vs. $85,055; antihypertension, $47,115 vs. $95,134), contributing to overall treatment costs increasing almost two-fold from 2010 to 2013. CONCLUSIONS Among HIV-infected Taiwanese patients receiving HAART, significant increases in comorbidity prevalence with age, along with rising comorbidity medication costs, suggest the need for preventative as well as chronic care.
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Álvarez-Moreno CA, González-Vélez AE, Colmenares-Mejía CC, Rincón-Ramírez KL, García-Buitrago JA, Rengifo-Bobadilla PA, Isaza-Ruget MA. The cost of hospital care for HIV patients in Colombia: an insurer's perspective. Int J STD AIDS 2019; 30:696-702. [PMID: 31046613 DOI: 10.1177/0956462419835636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the cost derived from the hospitalization of people living with HIV (PLHIV) in Colombia between 2011 and 2015. This is an analysis of the direct cost of PLHIV hospitalization from the perspective of an insurer of the Colombian General Social Security System. The costs were calculated in Colombian pesos and corrected for inflation on the basis of the 2017 Consumer Price Index of the Bank of the Republic of Colombia. It was converted to US dollars at the Market Representative Exchange Rate of the same year. We analyzed 1129 hospitalizations in 612 PLHIV, of which 12% started with a diagnosis of HIV during the same hospitalization, with the majority in the AIDS stage (63%). The median overall cost of hospitalizations was US$1509 (25th and 75th percentiles: US$711-US$3254), being even higher in patients with AIDS and as the CD4 T lymphocyte count decreased. The cost derived from the medical care of PLHIV increases as the clinical control of the disease worsens, and it is a key indicator of the impact of the strategies implemented for the timely identification of the infection and subsequent management of the disease.
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Krentz HB, Campbell S, Lahl M, Gill MJ. De-simplifying single-tablet antiretroviral treatments: uptake, risks and cost savings. HIV Med 2019; 20:214-221. [PMID: 30632660 DOI: 10.1111/hiv.12701] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES As more HIV-positive individuals receive antiretroviral therapy (ART), payers are seeking options for covering these increased and sustained drug costs. Strategic use of available generic antiretroviral (ARV) formulations may be feasible. De-simplifying a single-tablet co-formulation (STF) into two or more tablets using both brand and generic drugs has been proposed. We determine if voluntary de-simplification of one STF could be utilized as a cost-saving strategy. We report on the challenges, uptake, outcomes and cost savings of this initiative. METHODS Patients stable on the most commonly used STF (Triumeq® ) were offered the option of remaining on Triumeq® or switching to generic abacavir/lamivudine and Tivicay® between 1 January 2015 and 1 January 2018; those starting ART consisting of abacavir/lamivudine/doulutegravir in the same period were offered the option of starting Triumeq® or generic abacavir/laminvudine and Tivicay® . No incentives were provided. We examined the acceptance/decline rates, patient satisfaction, health care outcomes and annual cost savings. RESULTS Of 626 patients receiving Triumeq® , 321 were approached; 177 (55.1%) agreed to de-simplify. Of patients initiating ART, 62.7% chose the generic co-formulation. Patients switching to or starting on the generic co-formulation were more likely to be male, > 45 years old, Caucasian, men who have sex with men (MSM) and more HIV-experienced, and to have more comorbidities (all P < 0.05). Preference for STF was cited for declining de-simplification. No concern about generic ARVs was expressed. The rate of viral load > 500 HIV-1 RNA copies/mL after baseline was 2.7% in switched patients compared with 7.0% in those declining to switch. No de novo resistance occurred. A saving of Cdn$1 319 686 was achieved in the first year. CONCLUSIONS Reliance on altruism, while respecting patient autonomy, achieved de-simplification in > 50% of patients approached, and generated immediate cost savings with no increased risk of adverse events, viral breakthrough or resistance.
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Affiliation(s)
- H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Campbell
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M Lahl
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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Pierelli L, Vacca M, Zini G, Maresca M, Menichella G, Santinelli S, Stigliano MA, Mandarello G, Gasbarri R, Vaglio S. Emergency response of four transfusion centers during the last Chikungunya outbreak in Italy. Transfusion 2018; 58:3027-3030. [PMID: 30315667 DOI: 10.1111/trf.14892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/30/2018] [Accepted: 07/11/2018] [Indexed: 11/30/2022]
Abstract
Between September 15 and November 11, 2017, the area of Rome was subjected to cessation of donation in an area of approximately 1,300,000 inhabitants and with a 5-day quarantine for the rest of metropolitan areas due to Chikungunya virus (CHIKV) outbreak. Quarantine was applied to red blood cell (RBC) and plasma units while platelet concentrates (PCs) were subjected to pathogen inactivation methods (PIMs). Quarantine was based on an active recall of all donors and, in case of declared absence of any symptom or illness, on release of RBC and plasma units after 5 days. Four regional centers in which PIMs were already performed were charged for PIMs for the rest of Rome's area. These centers increased by 236% their previous PIM procedures, producing additional 1425 pathogen-reduced (PR) PCs in 57 days, beside their production (996 PR PCs) for local needs. The emergency support was close to the maximal production capacity of the four centers and was successful only thanks to the limited length of emergency. No adverse events were reported by all centers through a passive hemovigilance approach and by a follow-up of approximately 4 months. None of the donors referred symptoms or illness at recall and none of the blood products were discarded after quarantine. To date, no cases of CHIKV-transmitted infection were reported in transfused patients. This experience has taught some relevant strategic and organizing aspects that should be taken into account when an infectious outbreak must be faced in a large metropolitan area.
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Affiliation(s)
- Luca Pierelli
- Department of Experimental Medicine, Sapienza University Rome, Rome.,Transfusion Medicine, San Camillo Forlanini Hospital, Rome
| | - Michele Vacca
- Transfusion Medicine, San Camillo Forlanini Hospital, Rome
| | - Gina Zini
- Transfusion Medicine, A. Gemelli Hospital, Catholic University of Rome, Rome
| | - Maddalena Maresca
- Transfusion Medicine, A. Gemelli Hospital, Catholic University of Rome, Rome
| | | | | | | | | | - Roberto Gasbarri
- Transfusion Medicine, Belcolle Hospital/ASL Viterbo, Viterbo, Italy
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Abstract
OBJECTIVES To estimate the number of patients hospitalized for HIV-related reasons in France, to describe their characteristics and to estimate hospitalization-associated costs. DESIGN A retrospective analysis of the French hospital medical information database (Programme de médicalisation des systèmes d'information en médecine, chirurgie, obstétrique et odontologie database). METHODS Patients hospitalized with HIV in France in 2013 and 2014 were identified in the database through International Classification of Diseases, 10th revision diagnostic codes as well as comorbidities and opportunistic infections. Hospital stays for each patient were extracted over a 12-month period following the initial index hospitalization. Costing was performed from the perspective of national health insurance. Direct costs were attributed from national tariffs for medical acts and expressed in 2016 Euros. RESULTS During the study period, 70 180 stays, including day (80%) and overnight (20%) hospitalization, of patients with HIV were identified, of which 37 477 stays (by 20 126 patients) were directly related to HIV. In patients with overnight hospitalization, an opportunistic infection was documented in 50% of patients and at least one comorbidity were identified in 85% of patients. The overall estimated total annual cost of hospital stays was &OV0556; 64 126 616 (median annual cost per patient: &OV0556; 545). The median annual per capita cost was &OV0556; 541 for day hospitalization, &OV0556; 7664 for overnight stay with comorbidities and &OV0556; 9059 for overnight stay with opportunistic infections. CONCLUSION Most patients hospitalized with HIV in France presented an opportunistic infection or at least one comorbidity that contributed to costs of hospitalization. The organization of interfaces between different healthcare providers in hospital and community practice needs to be organized so that comorbidities are identified and managed optimally.
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Analysis of the costs and cost-effectiveness of the guidelines recommended by the 2018 GESIDA/Spanish National AIDS Plan for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2018; 37:151-159. [PMID: 29884455 DOI: 10.1016/j.eimc.2018.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The GESIDA/National AIDS Plan expert panel recommended preferred regimens (PR), alternative regimens (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2018. 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-effectiveness) based on decision tree analyses. Effectiveness 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) over the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting was Spain and the costs correspond to those of 2018. 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 6788 euros for TAF/FTC/RPV (AR) to 10,649 euros for TAF/FTC+RAL (PR). The effectiveness varies from 0.82 for TAF/FTC+DRV/r (AR) to 0.91 for TAF/FTC+DTG (PR). The efficiency, in terms of cost-effectiveness, ranges from 7814 to 12,412 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TAF/FTC+RAL (PR), respectively. CONCLUSION Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TAF/FTC/RPV (AR) and TAF/FTC/EVG/COBI (AR).
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Guillon M, Celse M, Geoffard PY. Economic and public health consequences of delayed access to medical care for migrants living with HIV in France. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:327-340. [PMID: 28343331 DOI: 10.1007/s10198-017-0886-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 03/13/2017] [Indexed: 05/26/2023]
Abstract
In 2013, migrants accounted for 46% of newly diagnosed cases of HIV (human immunodeficiency virus) infection in France. These populations meet with specific obstacles leading to late diagnosis and access to medical care. Delayed access to care (ATC) for HIV-infected migrants reduces their life expectancy and quality of life. Given the reduction of infectivity under antiretroviral (ARV) treatment, delayed ATC for HIV-infected migrants may also hinder the control of the HIV epidemic. The objective of this study is to measure the public health and economic consequences of delayed ATC for migrants living with HIV in France. Using a healthcare payer perspective, our model compares the lifetime averted infections and costs of early vs. late ATC for migrants living with HIV in France. Early and late ATC are defined by an entry into care with a CD4 cell count of 350 and 100/mm3, respectively. Our results show that an early ATC is dominant, even in the worst-case scenario. In the most favorable scenario, early ATC generates an average net saving of €198,000 per patient, and prevents 0.542 secondary infection. In the worst-case scenario, early ATC generates an average net saving of €32,000 per patient, and prevents 0.299 secondary infection. These results are robust to various adverse changes in key parameters and to a definition of late ATC as an access to care at a CD4 level of 200/mm3. In addition to individual health benefits, improving ATC for migrants living with HIV proves efficient in terms of public health and economics. These results stress the benefit of ensuring early ATC for all individuals living with HIV in France.
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Affiliation(s)
- Marlène Guillon
- Université Clermont Auvergne, CNRS, CERDI and Paris School of Economics, 63-65 Boulevard François Mitterrand, 63000, Clermont-Ferrand, France.
| | - Michel Celse
- Conseil National du Sida-French National AIDS Council, 39-43 Quai André Citroën, 75902, Paris Cedex 15, France
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Nosyk B, Min JE, Krebs E, Zang X, Compton M, Gustafson R, Barrios R, Montaner JSG. The Cost-Effectiveness of Human Immunodeficiency Virus Testing and Treatment Engagement Initiatives in British Columbia, Canada: 2011-2013. Clin Infect Dis 2018; 66:765-777. [PMID: 29028964 PMCID: PMC5850008 DOI: 10.1093/cid/cix832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023] Open
Abstract
Background Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013. Methods Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective. Results ED testing was the best value at $30216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV. Conclusions HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.
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Affiliation(s)
- Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Faculty of Health Sciences, Simon Fraser University, Burnaby
| | - Jeong E Min
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | | | - Xiao Zang
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | - Miranda Compton
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Lima TCD, Freitas MIPD. Cultural adaptation of Quality Of Care Through The Patient's Eyes -QUOTE-HIV. Rev Bras Enferm 2018; 71:47-56. [DOI: 10.1590/0034-7167-2016-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 03/06/2017] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to translate and adapt Quality of Care Through the Patient's Eyes - HIV (QUOTE-HIV) for the Brazilian population living with HIV/AIDS. Method: a methodological study, which followed the stages of translation, synthesis, back-translation, evaluation by the committee of experts and pre-test for cultural adaptation of the instrument. Results: the process of translation and cultural adaptation was considered adequate. Evaluation by the expert committee resulted in semantic, structural and grammatical adequacy of the evaluated items. 30 subjects considered the instrument to be easy to understand and suggested minor adjustments in some items. Conclusion: the Brazilian version of QUOTE-HIV has been adapted and validated in relation to its content. However, this is a study that precedes the process of evaluating the psychometric properties of the instrument, the results of which will be presented in a later publication.
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Krentz HB, Campbell S, Gill VC, Gill MJ. Patient perspectives on de-simplifying their single-tablet co-formulated antiretroviral therapy for societal cost savings. HIV Med 2018; 19:290-298. [PMID: 29368401 DOI: 10.1111/hiv.12578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The incremental costs of expanding antiretroviral (ARV) drug treatment to all HIV-infected patients are substantial, so cost-saving initiatives are important. Our objectives were to determine the acceptability and financial impact of de-simplifying (i.e. switching) more expensive single-tablet formulations (STFs) to less expensive generic-based multi-tablet components. We determined physician and patient perceptions and acceptance of STF de-simplification within the context of a publicly funded ARV budget. METHODS Programme costs were calculated for patients on ARVs followed at the Southern Alberta Clinic, Canada during 2016 (Cdn$). We focused on patients receiving Triumeq® and determined the savings if patients de-simplified to eligible generic co-formulations. We surveyed all prescribing physicians and a convenience sample of patients taking Triumeq® to see if, for budgetary purposes, they felt that de-simplification would be acceptable. RESULTS Of 1780 patients receiving ARVs, 62% (n = 1038) were on STF; 58% (n = 607) of patients on STF were on Triumeq®. The total annual cost of ARVs was $26 222 760. The cost for Triumeq® was $8 292 600. If every patient on Triumeq® switched to generic abacavir/lamivudine and Tivicay® (dolutegravir), total costs would decrease by $4 325 040. All physicians (n = 13) felt that de-simplifying could be safely achieved. Forty-eight per cent of 221 patients surveyed were agreeable to de-simplifying for altruistic reasons, 27% said no, and 25% said maybe. CONCLUSIONS De-simplifying Triumeq® generates large cost savings. Additional savings could be achieved by de-simplifying other STFs. Both physicians and patients agreed that selective de-simplification was acceptable; however, it may not be acceptable to every patient. Monitoring the medical and cost impacts of de-simplification strategies seems warranted.
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Affiliation(s)
- H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - S Campbell
- Southern Alberta Clinic, Calgary, AB, Canada
| | - V C Gill
- Southern Alberta Clinic, Calgary, AB, Canada
| | - M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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Abstract
OBJECTIVES We undertook the economic evaluation of the double-blind randomized ANRS-IPERGAY trial, which showed the efficacy of on-demand preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)-emtricitabine (FTC) in preventing HIV infection among high-risk MSM. DESIGN AND METHODS The economic evaluation was prospective. Counseling, drugs (TDF-FTC at &OV0556;500.88 for 30 tablets), tests, visits, and hospital admissions were valued based on in-trial use. The cost of on-demand PrEP/HIV infection averted was compared with the yearly and lifetime costs of HIV infection in France in a cost and benefits analysis. RESULTS The yearly number of participants needed to treat to prevent one HIV infection was 17.6 (95% confidence interval = 10.7-49.9). The annual cost of counseling was &OV0556;690/participant. The total 1-year costs of PrEP were &OV0556;4271/participant, of which &OV0556;3129 (73%) were drug costs corresponding to 15 tablets of TDF-FTC/month. The yearly cost of on-demand PrEP to avoid one infection was &OV0556;75 258. Using TDF-FTC generic (&OV0556;179.9/30 tablets) reduced the 1-year costs of on-demand PrEP to &OV0556;2271/participant and &OV0556;39 970/infection averted, respectively. Using TDF-FTC at international market discounted prices (&OV0556;60/30 tablets) reduced the costs to &OV0556;1517/participant and the cost to &OV0556;26 787/infection averted, comparable with the yearly treatment cost of HIV infection in France. On-demand PrEP was found to be cost saving in France if the duration of exposure was less than 7.5 years at current drug price and 13 years at generic price. CONCLUSION On-demand PrEP in high-risk MSM with TDF-FTC can be considered cost saving. Other benefits include the treatments of other diseases and reductions in secondary infections.
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Halperin J, Katz M, Pathmanathan I, Myers L, Van Sickels N, Seal PS, Richey LE. Early HIV Diagnosis Leads to Significantly Decreased Costs in the First 2 Years of HIV Care in an Urban Charity Hospital in New Orleans. J Int Assoc Provid AIDS Care 2017; 16:527-530. [PMID: 29076395 DOI: 10.1177/2325957417737381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We undertook a retrospective cohort study of patients with a positive HIV test in the emergency department who were then linked to care. Inpatient, outpatient, and emergency costs were collected for the first 2 years after HIV diagnosis. Fifty-six patients met the inclusion criteria; they were predominantly uninsured (73%) and African American (89%). The median total cost for a newly diagnosed patient over the first 2 years was US$36 808, driven predominantly by outpatient costs of US$17 512. Median inpatient and total costs were significantly different between the lowest (<200 cells/mm3) and highest (>499 cells/mm3) CD4 count categories (US$21 878 vs US$6607, P <.05; US$61 378 vs US$18 837, P <.05, respectively). Total costs were significantly different between viral load categories <100 000 HIV-RNA copies/mL and ≥100 000 HIV-RNA copies/mL (US$28 219 vs US$49 482, P <.05). Costs were significantly lower among patients diagnosed earlier in their disease. Decreased cost is another factor supporting early diagnosis and linkage to care for patients with HIV.
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Affiliation(s)
- Jason Halperin
- 1 Department of Internal Medicine, Tulane University Medical Center, New Orleans, LA, USA.,2 Present address: Crescent Care, New Orleans, LA USA
| | - Morgan Katz
- 1 Department of Internal Medicine, Tulane University Medical Center, New Orleans, LA, USA.,3 Present address: Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Ishani Pathmanathan
- 1 Department of Internal Medicine, Tulane University Medical Center, New Orleans, LA, USA
| | - Leann Myers
- 4 Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Nicholas Van Sickels
- 5 Section of Infectious Disease, Tulane University Medical Center, New Orleans, LA, USA
| | - Paula Sereebutra Seal
- 6 Section of Infectious Disease, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Lauren E Richey
- 5 Section of Infectious Disease, Tulane University Medical Center, New Orleans, LA, USA.,7 Present address: Section of Infectious Disease, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Pialoux G, Marcelin AG, Cawston H, Guilmet C, Finkielsztejn L, Laurisse A, Aubin C. Cost-effectiveness of dolutegravir/abacavir/lamivudine in HIV-1 treatment-Naive (TN) patients in France. Expert Rev Pharmacoecon Outcomes Res 2017; 18:83-91. [PMID: 28741965 DOI: 10.1080/14737167.2017.1359542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND To evaluate the cost-effectiveness of an integrase inhibitor (INI), dolutegravir (DTG), in combination with abacavir (ABC)/lamivudine (3TC) in France, in treatment-naive (TN) HIV adult patients. METHODS The ARAMIS microsimulation Markov model, evaluates costs and effects of DTG vs. first-line ARVs options including INIs (raltegravir, elvitegravir/c), protease inhibitors (PIs) (darunavir/r, atazanavir/r, lopinavir/r), non-nucleoside reverse transcriptase inhibitors (efavirenz and rilpivirine). Efficacy and safety data were derived from phase III studies and network meta-analysis. Treatment algorithms were based on French guidelines and experts opinion. Costs included routine HIV and opportunistic infection care, and death. RESULTS The model showed the fixed-dose combination DTG/ABC/3TC was more effective than all other recommended regimens: patients stayed longer on first-line, and lived longer and healthier. With the exception of EFV, DTG/ABC/3TC was more efficacious and less costly compared to all strategies. The cost per QALY gained (ICER) for DTG compared to EFV was €6,939. DTG/ABC/3TC was more efficacious and less costly compared to INIs and PIs in all deterministic sensitivity analyses. CONCLUSION DTG/ABC/3TC was cost-effective in the management of HIV TN patients in France. These results are mainly explained by its lower price compared to other INIs and PIs, DTG's superior efficacy and high barrier to resistance.
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Affiliation(s)
- Gilles Pialoux
- a Service des Maladies Infectieuses et Tropicales , AP-HP Hôpital Tenon , PARIS , France
| | - Anne-Geneviève Marcelin
- b Service de Virologie, Inserm UMR_S 1136 , UPMC Univ Paris 06, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles FoixParis , Paris , France
| | - Hélène Cawston
- c Real World Strategy & Analytics, Mapi Group , Nanterre , France
| | - Caroline Guilmet
- c Real World Strategy & Analytics, Mapi Group , Nanterre , France
| | | | - Audrey Laurisse
- e EU Payer Solution & Access Manager, Viiv Healthcare , Rueil-Malmaison , France
| | - Céline Aubin
- f Health Economics and Outcomes Research, Viiv Healthcare , Rueil-Malmaison , France
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Abstract
OBJECTIVES In this study, we first assessed costs associated with the use of antiretroviral therapy (ART) in an infectious diseases University Hospital Clinic; second, we evaluated characteristics associated with these costs and finally simulated the impact on the overall ART budget of switching first-line and second-line regimens to less-costly regimens (as effective and well tolerated). DESIGN Cohort analysis including persons living with HIV (PLHIV) aged at least 18 years on ART to estimate ART costs during 2014. METHODS The current study was conducted in the Bichat-Claude Bernard University Hospital Clinic in Paris, France, where 4501 PLHIV consulted in 2014. We used the medical database Nadis to describe patients' ART, characteristics and estimated costs. When assessing the budgetary impact of potential switches, we considered patients' history of failure, CD4 cell count, plasma viral load, resistance mutations, hepatitis B surface antigen or HLAB5701 profile. RESULTS A total of 4238 of 4501 patients were on ART (94%). The total annual cost of ART prescribed was estimated at &OV0556;48 280 200 in 2014; first/second (simplification)-line regimens represented 25% (1076/4238) of the treated PLHIV and 23% (&OV0556;11 209 000) of the annual cost. For these PLHIV, we considered switches from the most common ART regimens (protease inhibitor boosted by ritonavir or nonnucleoside reverse transcriptase inhibitor + two nucleoside reverse transcriptase inhibitors) to less-expensive regimens. We found savings ranging from &OV0556;36 100 to 1472 600/year. Savings were the highest when we considered switching to generic-based regimens or from protease inhibitor-based triple therapy to protease inhibitor monotherapy. CONCLUSION Costs associated with ART prescriptions are very high. Switches to generic-based regimens are associated with large savings. However, those targeting protease inhibitor regimens are also associated with substantial savings and should be considered.
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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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Ribera E, Martínez-Sesmero JM, Sánchez-Rubio J, Rubio R, Pasquau J, Poveda JL, Pérez-Mitru A, Roldán C, Hernández-Novoa B. Economic impact of optimising antiretroviral treatment in human immunodeficiency virus-infected adults with suppressed viral load in Spain, by implementing the grade A-1 evidence recommendations of the 2015 GESIDA/National AIDS Plan. Enferm Infecc Microbiol Clin 2017; 36:157-164. [PMID: 28109551 DOI: 10.1016/j.eimc.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/05/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective of this study is to estimate the economic impact associated with the optimisation of triple antiretroviral treatment (ART) in patients with undetectable viral load according to the recommendations from the GeSIDA/PNS (2015) Consensus and their applicability in the Spanish clinical practice. METHODS A pharmacoeconomic model was developed based on data from a National Hospital Prescription Survey on ART (2014) and the A-I evidence recommendations for the optimisation of ART from the GeSIDA/PNS (2015) consensus. The optimisation model took into account the willingness to optimise a particular regimen and other assumptions, and the results were validated by an expert panel in HIV infection (Infectious Disease Specialists and Hospital Pharmacists). The analysis was conducted from the NHS perspective, considering the annual wholesale price and accounting for deductions stated in the RD-Law 8/2010 and the VAT. RESULTS The expert panel selected six optimisation strategies, and estimated that 10,863 (13.4%) of the 80,859 patients in Spain currently on triple ART, would be candidates to optimise their ART, leading to savings of €15.9M/year (2.4% of total triple ART drug cost). The most feasible strategies (>40% of patients candidates for optimisation, n=4,556) would be optimisations to ATV/r+3TC therapy. These would produce savings between €653 and €4,797 per patient per year depending on baseline triple ART. CONCLUSION Implementation of the main optimisation strategies recommended in the GeSIDA/PNS (2015) Consensus into Spanish clinical practice would lead to considerable savings, especially those based in dual therapy with ATV/r+3TC, thus contributing to the control of pharmaceutical expenditure and NHS sustainability.
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Affiliation(s)
- Esteban Ribera
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | | | | | - Rafael Rubio
- Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, España
| | - Juan Pasquau
- Sección de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, España
| | - José Luis Poveda
- Servicio de Farmacia, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, España
| | | | - Celia Roldán
- Departamento Médico, Bristol-Myers Squibb, Madrid, España
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Deuffic-Burban S, Obach D, Canva V, Pol S, Roudot-Thoraval F, Dhumeaux D, Mathurin P, Yazdanpanah Y. Cost-effectiveness and budget impact of interferon-free direct-acting antiviral-based regimens for hepatitis C treatment: the French case. J Viral Hepat 2016; 23:767-79. [PMID: 27144512 DOI: 10.1111/jvh.12546] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/23/2016] [Indexed: 12/13/2022]
Abstract
We evaluated the cost-effectiveness and the budget impact of new DAA-based regimen use in France. A Markov model simulated chronic hepatitis C (CHC) treatment interventions with IFN-based and IFN-free regimens at stage of fibrosis ≥F3, ≥F2 or regardless of fibrosis stage, and treatment either with the least or the most expensive combination. It estimated quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). It also assessed the budget impact over 5 years of treating all CHC-screened patients, regardless of fibrosis, assuming ≤20 000 patients treated/year and priority to ≥F3. Sensitivity analyses were also conducted. For genotypes (G) 1-4, the initiation of IFN-free regardless of fibrosis was a cost-effective strategy compared to prior standard of care (SOC) initiated at stage F2: €40 400-88 300/QALY gained in G1; similar results were obtained for patients infected with G4. Considering G2-3, the most cost-effective strategy was IFN-based regimens regardless of fibrosis compared to prior SOC initiated at stage F2: €21 300 and €19 400/QALY gained, respectively; the strategy with IFN-free regimens being more effective but not cost-effective at current costs. The budget impact of treating all CHC-screened patients over 5 years would range between 3.5 and 7.2 billion €, depending on whether one considers the least or the most expensive combination of new DAAs and whether one treats G2-3 with IFN-based or IFN-free new DAAs. In France, treatment initiation with new DDAs regardless of fibrosis stage is cost-effective, but would add 3.5-7.2 billion € to an already overburdened medical care system.
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Affiliation(s)
- S Deuffic-Burban
- Inserm, IAME, UMR 1137, Paris, France. .,Univ Paris Diderot, Sorbonne Paris Cité, Paris, France. .,Univ Lille Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International, Lille, France.
| | - D Obach
- Inserm, IAME, UMR 1137, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - V Canva
- Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHU Lille, Lille, France
| | - S Pol
- Unité d'hépatologie, Groupe Hospitalier Cochin Hôtel-Dieu, Paris, France.,Inserm U1016, Univ Paris Descartes, Paris, France
| | | | - D Dhumeaux
- Inserm U955, Hôpital Henri Mondor, Créteil, France
| | - P Mathurin
- Univ Lille Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International, Lille, France.,Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHU Lille, Lille, France
| | - Y Yazdanpanah
- Inserm, IAME, UMR 1137, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
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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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Treskova M, Kuhlmann A, Bogner J, Hower M, Heiken H, Stellbrink HJ, Mahlich J, von der Schulenburg JMG, Stoll M. Analysis of contemporary HIV/AIDS health care costs in Germany: Driving factors and distribution across antiretroviral therapy lines. Medicine (Baltimore) 2016; 95:e3961. [PMID: 27367993 PMCID: PMC4937907 DOI: 10.1097/md.0000000000003961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To analyze contemporary costs of HIV health care and the cost distribution across lines of combination antiretroviral therapy (cART). To identify variations in expenditures with patient characteristics and to identify main cost determinants. To compute cost ratios between patients with varying characteristics.Empirical data on costs are collected in Germany within a 2-year prospective observational noninterventional multicenter study. The database contains information for 1154 HIV-infected patients from 8 medical centers.Means and standard deviations of the total costs are estimated for each cost fraction and across cART lines and regimens. The costs are regressed against various patient characteristics using a generalized linear model. Relative costs are calculated using the resultant coefficients.The average annual total costs (SD) per patient are &OV0556;22,231.03 (8786.13) with a maximum of &OV0556;83,970. cART medication is the major cost fraction (83.8%) with a mean of &OV0556;18,688.62 (5289.48). The major cost-driving factors are cART regimen, CD4-T cell count, cART drug resistance, and concomitant diseases. Viral load, pathology tests, and demographics have no significant impact. Standard non-nucleoside reverse transcriptase inhibitor-based regimens induce 28% lower total costs compared with standard PI/r regimens. Resistance to 3 or more antiretroviral classes induces a significant increase in costs.HIV treatment in Germany continues to be expensive. Majority of costs are attributable to cART. Main cost determinants are CD4-T cells count, comorbidity, genotypic antiviral resistance, and therapy regimen. Combinations of characteristics associated with higher expenditures enhance the increasing effect on the costs and induce high cost cases.
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Affiliation(s)
- Marina Treskova
- Center for Health Economics Research Hannover, Hannover
- Correspondence: Marina Treskova, Gottfried Wilhelm Leibniz Universität Hannover, Center for Health Economics Research Hannover Institut für Versicherungsbetriebslehre Otto-Brenner-Str. 1, 30159 Hannover, Germany (e-mail: )
| | | | - Johannes Bogner
- Sektion Klinische Infektiologie, Med IV, Klinikum der Universität München, Munich
| | - Martin Hower
- ID-Ambulanz der Medizinischen Klinik Nord, Klinikum Dortmund, Dortmund
| | - Hans Heiken
- Innere Medizin, Praxis Georgstraße, Hannover
| | | | - Jörg Mahlich
- Health Economics & Pricing, Janssen-Cilag GmbH, Neuss
| | | | - Matthias Stoll
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Germany
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Saxena D, Spino M, Tricta F, Connelly J, Cracchiolo BM, Hanauske AR, D’Alliessi Gandolfi D, Mathews MB, Karn J, Holland B, Park MH, Pe’ery T, Palumbo PE, Hanauske-Abel HM. Drug-Based Lead Discovery: The Novel Ablative Antiretroviral Profile of Deferiprone in HIV-1-Infected Cells and in HIV-Infected Treatment-Naive Subjects of a Double-Blind, Placebo-Controlled, Randomized Exploratory Trial. PLoS One 2016; 11:e0154842. [PMID: 27191165 PMCID: PMC4871512 DOI: 10.1371/journal.pone.0154842] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/18/2016] [Indexed: 01/19/2023] Open
Abstract
UNLABELLED Antiretrovirals suppress HIV-1 production yet spare the sites of HIV-1 production, the HIV-1 DNA-harboring cells that evade immune detection and enable viral resistance on-drug and viral rebound off-drug. Therapeutic ablation of pathogenic cells markedly improves the outcome of many diseases. We extend this strategy to HIV-1 infection. Using drug-based lead discovery, we report the concentration threshold-dependent antiretroviral action of the medicinal chelator deferiprone and validate preclinical findings by a proof-of-concept double-blind trial. In isolate-infected primary cultures, supra-threshold concentrations during deferiprone monotherapy caused decline of HIV-1 RNA and HIV-1 DNA; did not allow viral breakthrough for up to 35 days on-drug, indicating resiliency against viral resistance; and prevented, for at least 87 days off-drug, viral rebound. Displaying a steep dose-effect curve, deferiprone produced infection-independent deficiency of hydroxylated hypusyl-eIF5A. However, unhydroxylated deoxyhypusyl-eIF5A accumulated particularly in HIV-infected cells; they preferentially underwent apoptotic DNA fragmentation. Since the threshold, ascertained at about 150 μM, is achievable in deferiprone-treated patients, we proceeded from cell culture directly to an exploratory trial. HIV-1 RNA was measured after 7 days on-drug and after 28 and 56 days off-drug. Subjects who attained supra-threshold concentrations in serum and completed the protocol of 17 oral doses, experienced a zidovudine-like decline of HIV-1 RNA on-drug that was maintained off-drug without statistically significant rebound for 8 weeks, over 670 times the drug's half-life and thus clearance from circulation. The uniform deferiprone threshold is in agreement with mapping of, and crystallographic 3D-data on, the active site of deoxyhypusyl hydroxylase (DOHH), the eIF5A-hydroxylating enzyme. We propose that deficiency of hypusine-containing eIF5A impedes the translation of mRNAs encoding proline cluster ('polyproline')-containing proteins, exemplified by Gag/p24, and facilitated by the excess of deoxyhypusine-containing eIF5A, releases the innate apoptotic defense of HIV-infected cells from viral blockade, thus depleting the cellular reservoir of HIV-1 DNA that drives breakthrough and rebound. TRIAL REGISTRATION ClinicalTrial.gov NCT02191657.
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Affiliation(s)
- Deepti Saxena
- Department of Pediatrics, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
| | - Michael Spino
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- ApoPharma Inc., Toronto, Ontario, Canada
| | | | | | - Bernadette M. Cracchiolo
- Department of Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
| | - Axel-Rainer Hanauske
- Oncology Center and Medical Clinic III, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Michael B. Mathews
- Department of Medicine, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
| | - Jonathan Karn
- Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Bart Holland
- Department of Medicine, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
| | - Myung Hee Park
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institute of Health, Bethesda, Maryland, United States of America
| | - Tsafi Pe’ery
- Department of Medicine, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
| | - Paul E. Palumbo
- Department of Pediatrics, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
- * E-mail: (PEP); (HMHA)
| | - Hartmut M. Hanauske-Abel
- Department of Pediatrics, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
- Department of Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States of America
- * E-mail: (PEP); (HMHA)
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Abou-El-Enein M, Bauer G, Reinke P. Gene therapy: a possible future standard for HIV care. Trends Biotechnol 2016; 33:374-6. [PMID: 26088914 DOI: 10.1016/j.tibtech.2015.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/09/2015] [Accepted: 03/20/2015] [Indexed: 11/28/2022]
Abstract
Despite undeniable accomplishments in developing cell and gene therapeutic strategies to combat HIV infection, key social, economic, and policy-related challenges still need to be overcome for any future commercialization efforts of these novel therapies to be successful. Here, we address these challenges and structure a framework for eradicating HIV/AIDS using gene therapy.
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Affiliation(s)
- Mohamed Abou-El-Enein
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany.
| | - Gerhard Bauer
- University of California Davis, Institute For Regenerative Cures (IRC) Sacramento, CA, USA
| | - Petra Reinke
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
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Yazdanpanah Y, Schwarzinger M. Generic antiretroviral drugs and HIV care: An economic review. Med Mal Infect 2016; 46:67-71. [PMID: 26905394 DOI: 10.1016/j.medmal.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 11/30/2015] [Accepted: 01/15/2016] [Indexed: 11/16/2022]
Abstract
The cost of HIV care in European countries is high. Direct medical costs, in France, have been estimated at 500,000 Euros per patient's lifetime (20,000 Euros/year/patient). Overall, 73% of these costs are related to antiretroviral treatments. In the current financial crisis context, some European countries are beginning to make economic decisions on the drugs to be used. These approaches are likely to become more frequent. It is obviously essential to prescribe the most effective, appropriate, best tolerated, and easy-to-use antiretroviral treatments to patients. However, while taking the above into consideration, and if various treatment options or combinations are available, cost should also be considered in the treatment choice. One may thus reflect on the use of generic antiretroviral agents as they have just been launched in France. We aimed to review the cost and cost-effectiveness of generic antiretroviral drugs and to review treatment strategies other than generic drugs that could help reduce HIV-related costs. HIV clinicians should consider treatment costs to avoid any future coercive measures.
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Affiliation(s)
- Y Yazdanpanah
- UMR 1137, Inserm, IAME, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France; Service des maladies infectieuses et tropicales, hôpital Bichat, AP-HP, 75018 Paris, France.
| | - M Schwarzinger
- UMR 1137, Inserm, IAME, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
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Abstract
PURPOSE OF REVIEW We aim to review the strengths and weaknesses of current antiretroviral therapy (ART), and describe ongoing research to address limitations to current therapy. RECENT FINDINGS Current ART is highly effective and well tolerated. As a result of a decrease in medication side-effects and pill burden, and the known health effects of uncontrolled viremia, ART is now recommended at all CD4 cell counts in the USA. Novel medications are being developed to further decrease side-effects and offer alternative options for patients with multiclass resistance. New combination pills will further decrease pill burden. SUMMARY Current treatment for HIV is characterized by highly potent oral antiretroviral medications, which are well tolerated, resulting in outstanding rates of virologic suppression in patients who are adherent to therapy. Despite the marked improvement in therapeutic options, limitations to therapy still exist including reliance on daily adherence, long-term toxicity of medications, drug-drug interactions, long-term effects of HIV even in the setting of viral suppression, high lifetime cost of treatment, and limited options for some patients with multiclass resistance. Emerging alternative treatment strategies include nucleoside reverse transcriptase inhibitor-sparing or limiting regimens and long-acting injectable combination therapy.
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Sweet DE, Altice FL, Cohen CJ, Vandewalle B. Cost-Effectiveness of Single- Versus Generic Multiple-Tablet Regimens for Treatment of HIV-1 Infection in the United States. PLoS One 2016; 11:e0147821. [PMID: 26808503 PMCID: PMC4725959 DOI: 10.1371/journal.pone.0147821] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/08/2016] [Indexed: 11/17/2022] Open
Abstract
Background The possibility of incorporating generics into combination antiretroviral therapy and breaking apart once-daily single-tablet regimens (STRs), may result in less efficacious medications and/or more complex regimens with the expectation of marked monetary savings. A modeling approach that assesses the merits of such policies in terms of lifelong costs and health outcomes using adherence and effectiveness data from real-world U.S. settings. Methods A comprehensive computer-based microsimulation model was developed to assess the lifetime health (life expectancy and quality adjusted life-years—QALYs) and economic outcomes in HIV-1 infected patients initiating STRs compared with multiple-table regimens including generic medications where possible (gMTRs). The STRs considered included tenofovir disoproxil fumarate/emtricitabine and efavirenz or rilpivirine or elvitegravir/cobicistat. gMTRs substitutions included each counterpart to STRs, including generic lamivudine for emtricitabine and generic versus branded efavirenz. Results Life expectancy is estimated to be 1.301 years higher (discounted 0.619 QALY gain) in HIV-1 patients initiating a single-tablet regimen in comparison to a generic-based multiple-table regimen. STRs were associated with an average increment of $26,547.43 per patient in medication and $1,824.09 in other medical costs due to longer survival which were partially offset by higher inpatients costs ($12,035.61) with gMTRs treatment. Overall, STRs presented incremental lifetime costs of $16,335.91 compared with gMTRs, resulting in an incremental cost-effectiveness ratio of $26,383.82 per QALY gained. Conclusions STRs continue to represent good value for money under contemporary cost-effectiveness thresholds despite substantial price reductions of generic medications in the U. S.
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Affiliation(s)
- Donna E Sweet
- Internal Medicine, The University of Kansas School of Medicine-Wichita, Wichita, Kansas, United States of America
| | - Frederick L Altice
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Calvin J Cohen
- CRI New England, Boston, Massachusetts, United States of America
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Kušić J, Mladenović M, Dimitrijević B, Aleksić B, Zec S, Jevtović D, Dragović Lukić G. Treatment outcomes of first-line antiretroviral therapy in HIV-1-positive patients in Serbia. J Virus Erad 2016; 2:32-5. [PMID: 27482433 PMCID: PMC4946693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Access to combination antiretroviral treatment (cART) and toxicity profiles of antiretroviral medications have significantly improved during the last three decades. In order to optimise treatment outcomes, achieve favourable virological suppression and immunological status, balanced with potential adverse effects of cART, it is considered beneficial to maintain first-line antiretroviral treatment for as long as possible. However, the Republic of Serbia, as a resource-limited setting, often experiences interruptions to drug supplies. Data are very limited in Serbia concerning the initial antiretroviral regimens prescribed and the reasons for treatment changes. AIMS The aim of this study was to determine the most frequently prescribed antiretroviral drugs within first-line cART regimens in drug-naïve patients in Serbia and the reasons for switching drugs. METHODS All HIV-infected individuals who started cART at the HIV/AIDS Center of Infectious and Tropical Diseases, Clinical Centre of Serbia, from 1 January 2004 until 1 July 2014 were included. A cohort of 339 patients were retrospectively analysed to review their initial treatment regimens. All analyses were performed using the SPSS statistical package version 11.0. Descriptive measurements and Kaplan-Meier survival curves were used. RESULTS The most frequently prescribed nucleoside reverse transcriptase inhibitor (NRTI) backbones in the cART regiment were fixed combinations of abacavir and lamivudine (n=181, 53.3%) and of zidovudine and lamivudine (n=103, 30.5%). Efavirenz was the most commonly prescribed 'third' drug (n=254, 75%). Where given, reasons for switching initial cART were shortage of antiretroviral drugs (e.g. out of stock, n=53, 37.6%), toxicity (n=49, 34.3%), physician choice (n=21, 14.6%), resistance (n=15, 10.6%), and patient choice (n=4, 2.9%). Mean duration of first-line cART was 20±17 months. CONCLUSION The most frequently prescribed initial cART regimen in Serbia is not the preferred first choice, but an alternative option according to the international antiretroviral treatment guidelines. Duration of first-line cART is short and a switch to second-line cART is often made due to a shortage of antiretroviral medications and the more severe side effects resulting from the use of older drugs.
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Affiliation(s)
- Jovana Kušić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Božana Dimitrijević
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branka Aleksić
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Simon Zec
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Djordje Jevtović
- Infectious and Tropical Diseases Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gordana Dragović Lukić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
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Kušić J, Mladenović M, Dimitrijević B, Aleksić B, Zec S, Jevtović D, Dragović Lukić G. Treatment outcomes of first-line antiretroviral therapy in HIV-1-positive patients in Serbia. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30690-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Experienced (TE) Patients in France. PLoS One 2015; 10:e0145885. [PMID: 26714188 PMCID: PMC4699888 DOI: 10.1371/journal.pone.0145885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 12/09/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate the cost-effectiveness of a new generation integrase inhibitor (INI), dolutegravir (DTG), in France, in treatment-experienced (TE) and INI-naïve HIV-infected adults with at least two classes resistance compared to raltegravir (RAL), by adapting previously published Anti-Retroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model. Methods ARAMIS is a microsimulation Markov model with a lifetime time horizon and a monthly cycle length. Health states are defined as with or without opportunistic infection and death. In the initial cohort, efficacy and safety data were derived from a phase III study comparing DTG to RAL. Antiretroviral treatment algorithms, accounting for patient history, were based on French guidelines and experts opinion. Costs are mainly including treatment costs, routine HIV and opportunistic infection care, and death. Utilities depend on CD4+ cell count and the occurrence of opportunistic infections. Results The ARAMIS model indicates in the TE population that DTG compared to RAL over a life time is associated with 0.35 additional quality-adjusted life years (QALY; 10.75 versus 10.41) and additional costs of €7,266 (€390,001 versus €382,735). DTG increased costs are mainly related to a 9.1-month increase in life expectancy for DTG compared with RAL, and consequently a longer time spent on ART. The incremental cost-effectiveness ratio (ICER) for DTG compared with RAL is €21,048 per QALY gained. About 83% and 14% of total lifetime costs are associated with antiretroviral therapy and routine HIV care respectively. Univariate deterministic sensitivity analyses demonstrate the robustness of the model. Conclusion DTG is cost-effective in the management of TE INI naive patients in France, from a collective perspective. These results could be explained by the superior efficacy of DTG in this population and its higher genetic barrier to resistance compared to RAL. These data need to be confirmed with longer-term real life data.
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Mabileau G, Schwarzinger M, Flores J, Patrat C, Luton D, Epelboin S, Mandelbrot L, Matheron S, Yazdanpanah Y. HIV-serodiscordant couples desiring a child: 'treatment as prevention,' preexposure prophylaxis, or medically assisted procreation? Am J Obstet Gynecol 2015; 213:341.e1-12. [PMID: 25979615 DOI: 10.1016/j.ajog.2015.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We sought to assess the residual risk of HIV transmission, cost, and cost-effectiveness of various strategies that can help fertile HIV-uninfected female/HIV-1-infected male on combination antiretroviral therapy with plasma HIV RNA <50 copies/mL couples to have a child: (1) unprotected sexual intercourse (treatment as prevention); (2) treatment as prevention limited to fertile days (targeting fertile days); (3) treatment as prevention with preexposure prophylaxis (tenofovir/emtricitabine); (4) treatment as prevention and preexposure prophylaxis limited to fertile days; or (5) medically assisted procreation (MAP). STUDY DESIGN This was a model-based, cost-effectiveness analysis performed from a French societal perspective. Input parameters derived from international literature included: 85% probability of live births in different strategies, 0.0083%/mo HIV transmission risk with unprotected vaginal intercourse, 1% HIV mother-to-child transmission rate, and 4.4% birth defect risk related to combination antiretroviral therapy when the mother is infected at conception. Targeting fertile days and preexposure prophylaxis were estimated to decrease the risk of HIV transmission by 80% and 67%, respectively, and by 93.4% for preexposure prophylaxis limited to fertile days (the relative risk of transmission considering the combination of both strategies assuming to be (1-80%)*(1-67%) = 16.6% in basecase). Tenofovir/emtricitabine monthly cost was set at €540. RESULTS The HIV transmission risk was highest with treatment as prevention and lowest for MAP (5.4 and 0.0 HIV-infected women/10,000 pregnancies, respectively). Targeting fertile days was more effective than preexposure prophylaxis (0.9 vs 1.8) and associated with lowest costs. Preexposure prophylaxis limited to fertile days was more effective than targeting fertile days (0.3 vs 0.9) with a cost-effectiveness ratio of €1,130,000/life year saved; MAP cost-effectiveness ratio when compared with preexposure prophylaxis limited to fertile days was €3,600,000/life year saved. Results were robust to multiple sensitivity analyses. CONCLUSION Targeting fertile days is associated with a low risk of HIV transmission in fertile HIV-uninfected female/male with controlled HIV-1 infection couples. The risk is lower with preexposure prophylaxis limited to fertile days, or MAP, but these strategies are associated with unfavorable cost-effectiveness ratios under their current costs.
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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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Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Naive and Treatment-Experienced Patients in Canada. Infect Dis Ther 2015; 4:337-53. [PMID: 26099626 PMCID: PMC4575289 DOI: 10.1007/s40121-015-0071-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 01/16/2023] Open
Abstract
Introduction The Antiretroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model was adapted to evaluate the cost-effectiveness of dolutegravir (DTG) in Canada in treatment-naive (TN) and treatment-experienced (TE) human immunodeficiency virus (HIV)-1 patients. Methods The ARAMIS-DTG model is a microsimulation model with a lifetime analytic time horizon and a monthly cycle length. Markov health states were defined by HIV health state (with or without opportunistic infection). DTG was compared to efavirenz (EFV), raltegravir (RAL), darunavir/ritonavir, rilpivirine (RPV), elvitegravir/cobicistat, atazanavir/ritonavir and lopinavir/ritonavir in TN patients and to RAL in TE patients. The initial cohort, the main efficacy data and safety data were derived from phase III clinical trials. Treatment algorithms were based on expert opinion. Costs normalized to the year 2013 included antiretroviral treatment cost, testing, adverse event, HIV and cardiovascular disease care and were derived from the literature. Results Dolutegravir was estimated to be the dominant strategy compared with all comparators in both TN and TE patients. Treatment with DTG was associated with additional quality-adjusted life-years that ranged from 0.17 (vs. RAL) to 0.47 (vs. EFV) in TN patients and was 0.60 in TE patients over a lifetime. Cost savings ranged from Can$1393 (vs. RPV) to Can$28,572 (vs. RAL) in TN patients and amounted to Can$3745 in TE patients. Sensitivity analyses demonstrated the robustness of the model. Conclusions Dolutegravir is a dominant strategy in the management of TN and TE patients when compared to recommended comparators. This is mainly related to the high efficacy and high barrier to resistance. Funding ViiV Healthcare. Electronic supplementary material The online version of this article (doi:10.1007/s40121-015-0071-0) contains supplementary material, which is available to authorized users.
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Projected Lifetime Healthcare Costs Associated with HIV Infection. PLoS One 2015; 10:e0125018. [PMID: 25901355 PMCID: PMC4406522 DOI: 10.1371/journal.pone.0125018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/08/2015] [Indexed: 11/25/2022] Open
Abstract
Objective Estimates of healthcare costs associated with HIV infection would provide valuable insight for evaluating the cost-effectiveness of possible prevention interventions. We evaluate the additional lifetime healthcare cost incurred due to living with HIV. Methods We used a stochastic computer simulation model to project the distribution of lifetime outcomes and costs of men-who-have-sex-with-men (MSM) infected with HIV in 2013 aged 30, over 10,000 simulations. We assumed a resource-rich setting with no loss to follow-up, and that standards and costs of healthcare management remain as now. Results Based on a median (interquartile range) life expectancy of 71.5 (45.0–81.5) years for MSM in such a setting, the estimated mean lifetime cost of treating one person was £360,800 ($567,000 or €480,000). With 3.5% discounting, it was £185,200 ($291,000 or €246,000). The largest proportion (68%) of these costs was attributed to antiretroviral drugs. If patented drugs are replaced by generic versions (at 20% cost of patented prices), estimated mean lifetime costs reduced to £179,000 ($281,000 or €238,000) and £101,200 ($158,900 or €134,600) discounted. Conclusions If 3,000 MSM had been infected in 2013, then future lifetime costs relating to HIV care is likely to be in excess of £1 billion. It is imperative for investment into prevention programmes to be continued or scaled-up in settings with good access to HIV care services. Costs would be reduced considerably with use of generic antiretroviral drugs.
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Schackman BR, Fleishman JA, Su AE, Berkowitz BK, Moore RD, Walensky RP, Becker JE, Voss C, Paltiel AD, Weinstein MC, Freedberg KA, Gebo KA, Losina E. The lifetime medical cost savings from preventing HIV in the United States. Med Care 2015; 53:293-301. [PMID: 25710311 PMCID: PMC4359630 DOI: 10.1097/mlr.0000000000000308] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Enhanced HIV prevention interventions, such as preexposure prophylaxis for high-risk individuals, require substantial investments. We sought to estimate the medical cost saved by averting 1 HIV infection in the United States. METHODS We estimated lifetime medical costs in persons with and without HIV to determine the cost saved by preventing 1 HIV infection. We used a computer simulation model of HIV disease and treatment (CEPAC) to project CD4 cell count, antiretroviral treatment status, and mortality after HIV infection. Annual medical cost estimates for HIV-infected persons, adjusted for age, sex, race/ethnicity, and transmission risk group, were from the HIV Research Network (range, $1854-$4545/mo) and for HIV-uninfected persons were from the Medical Expenditure Panel Survey (range, $73-$628/mo). Results are reported as lifetime medical costs from the US health system perspective discounted at 3% (2012 USD). RESULTS The estimated discounted lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% nondrug costs). For individuals who remain uninfected but at high risk for infection, the discounted lifetime cost estimate is $96,700. The medical cost saved by avoiding 1 HIV infection is $229,800. The cost saved would reach $338,400 if all HIV-infected individuals presented early and remained in care. Cost savings are higher taking into account secondary infections avoided and lower if HIV infections are temporarily delayed rather than permanently avoided. CONCLUSIONS The economic value of HIV prevention in the United States is substantial given the high cost of HIV disease treatment.
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Affiliation(s)
- Bruce R Schackman
- *Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY †Agency for Healthcare Research and Quality, Rockville, MD ‡Division of General Internal Medicine §Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA ∥Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD ¶Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA #Center for AIDS Research, Harvard University, Cambridge, MA **Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA ††Department of Health Policy and Management, Yale School of Public Health, New Haven, CT ‡‡Department of Health Policy and Management, Harvard School of Public Health, Boston, MA §§Department of Epidemiology, Boston University School of Public Health, Boston, MA ∥∥Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA ¶¶Department of Biostatistics, Boston University School of Public Health, Boston, MA
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Nosyk B, Lima V, Colley G, Yip B, Hogg RS, Montaner JSG. Costs of health resource utilization among HIV-positive individuals in British Columbia, Canada: results from a population-level study. PHARMACOECONOMICS 2015; 33:243-53. [PMID: 25404425 PMCID: PMC4677778 DOI: 10.1007/s40273-014-0229-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Through delayed HIV disease progression, highly active antiretroviral therapy (HAART) may reduce direct medical costs, thus at least partially offsetting therapy costs. Recent findings regarding the secondary preventive benefits of HAART necessitate careful consideration of funding allocations for HIV/AIDS care. Our objective is to estimate non-HAART direct medical costs at different levels of disease progression and over time in British Columbia, Canada. METHODS We considered the population of individuals with HIV/AIDS within a set of linked disease registries and health administrative databases (N = 11,836) from 1996 to 2010. Costs of hospitalization, physician billing, diagnostic testing and non-HAART medications were calculated in 2010 Canadian dollars. Effects of covariates on quarterly costs were assessed with a two-part model with logit for probability of non-zero costs and a generalized linear model (GLM). Net effects of CD4 strata on direct non-HAART medical costs were evaluated over time during the study period. RESULTS Compared with person-quarters in which CD4 >500/mm(3), costs were Can$185 (95 % confidence interval [CI] 132-239) greater for CD4 350-500/mm(3), Can$441 (95 % CI 366-516) greater for CD4 200-350/mm(3) and Can$1,173 (95 % CI 1,051-1,294) greater when CD4 <200/mm(3). Prior to HIV care initiation, individuals incurred costs Can$385 (95 % CI 283-487) greater than in periods with CD4 >500/mm(3). Hospitalization comprised the majority of the increment in costs amongst those with no measured CD4. Evaluated at CD4 state conditional means, those with CD4 <200/mm(3) incurred quarterly costs of Can$5,781 (95 % CI 4,716-6,846) versus Can$1,307 (95 % CI 1,154-1,460; p < 0.001) for CD4 ≥500/mm(3) in 2010. CONCLUSION Non-HAART direct medical costs were substantially lower for individuals during periods of sustained virologic suppression and high CD4 count. HIV treatment and prevention evaluations require detailed health resource use data to inform funding allocation decisions.
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Affiliation(s)
- Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Providence Healthcare, 1081 Burrard St., Room 667, Vancouver, BC, V6Z 1Y6, Canada,
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