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Perrone V, Dovizio M, Sangiorgi D, Andretta M, Bartolini F, Cavaliere A, Ciaccia A, Chinellato A, Costantini A, Dell’Orco S, Ferrante F, Gentile S, Lavalle A, Moscogiuri R, Mosele E, Procacci C, Re D, Santoleri F, Roccia A, Maggiolo F, Degli Esposti L. Healthcare Resource Consumption and Related Costs in Patients on Antiretroviral Therapies: Findings from Real-World Data in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3789. [PMID: 36900813 PMCID: PMC10000772 DOI: 10.3390/ijerph20053789] [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: 01/31/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
This real-world analysis conducted on administrative databases of a sample of Italian healthcare entities was aimed at describing the role of therapeutic pathways and drug utilization in terms of adherence, persistence, and therapy discontinuation in HIV-infected patients under antiretroviral therapies (ART) and Tenofovir Alafenamide (TAF)-based regimens on healthcare resource consumption and related direct healthcare costs. Between 2015 and 2019, adults (≥18 years) prescribed with TAF-based therapies were identified and characterized in the year prior to the first prescription (index-date) for TAF-based therapies and followed-up until the end of data availability. Overall, 2658 ART-treated patients were included, 1198 of which were under a TAF-based regimen. TAF-based therapies were associated with elevated percentages of adherence (83.3% patients with proportion of days covered, PDC > 95% and 90.6% with PDC > 85%) and persistence (78.5%). The discontinuation rate was low in TAF-treated patients, ranging from 3.3% in TAF-switchers to 5% in naïve. Persistent patients had lower overall mean annual healthcare expenditures (EUR 11,106 in persistent vs. EUR 12,380 in non-persistent, p = 0.005), and this trend was statistically significant also for costs related to HIV hospitalizations. These findings suggest that a better therapeutic management of HIV infection might result in positive clinical and economic outcomes.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | | | | | | | - Andrea Ciaccia
- Servizio Farmaceutico Territoriale ASL Foggia, 71121 Foggia, Italy
| | | | | | | | | | - Simona Gentile
- Direzione Generale per la Salute Regione Molise, 86100 Campobasso, Italy
| | - Antonella Lavalle
- Direzione Generale per la Salute Regione Molise, 86100 Campobasso, Italy
| | | | - Elena Mosele
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 7 Pedemontana, 36061 Bassano del Grappa, Italy
| | | | | | | | | | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
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Valbert F, Wolf E, Schewe K, Klauke S, Hanhoff N, Hoffmann C, Preis S, Pahmeier K, Wasem J, Neumann A. Cost of Human Immunodeficiency Virus (HIV) and Determinants of Healthcare Costs in HIV-Infected Treatment-Naive Patients Initiated on Antiretroviral Therapy in Germany: Experiences of the PROPHET Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1324-1331. [PMID: 33032776 DOI: 10.1016/j.jval.2020.04.1836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/16/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The purpose of the prospective clinical and pharmacoeconomic outcomes study of different first-line antiretroviral treatment strategies (PROPHET) was to examine the healthcare costs of human immunodeficiency virus (HIV)-infected persons in Germany treated with different antiretroviral therapy (ART) strategies and to identify variables associated with high costs. METHODS The setting was a 24-month prospective multicenter observational cohort study in a German HIV-specialized care setting from 2014 to 2017. A microcosting approach was used for the estimation of healthcare costs. Data were obtained via electronic case report forms. The costs were calculated from both the societal and the statutory health insurance perspective. Regression models were performed that took into consideration the impact of several independent variables. RESULTS Four hundred thirty-four patients from 24 centers throughout Germany were included. Average annual healthcare costs were €20 118 (standard deviation [SD] €6451) per patient from the societal perspective (n = 336) and €17 306 (SD €4106) from the statutory health insurance perspective (n = 292). Expenditures for the ART medication had the highest impact. Total costs declined in the second year of therapy. There was a significant association between the amount of total cost and clinical or therapeutic variables from both perspectives; a diagnosis of acquired immune deficiency syndrome (AIDS) led to higher costs as well as the chosen ART strategy. Age also increased cost from the statutory health insurance perspective. CONCLUSIONS The main cost driver of the healthcare costs for HIV-positive patients was antiretroviral drug expenses. Further variables that influenced the costs were identified. The results provide a detailed overview of the resource use of patients in the PROPHET cohort.
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Affiliation(s)
- Frederik Valbert
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany.
| | - Eva Wolf
- MUC Research GmbH, Munich, Germany
| | - Knud Schewe
- German Association of Physicians Specializing in HIV Care Registered Association, Berlin, Germany
| | | | - Nikola Hanhoff
- German Association of Physicians Specializing in HIV Care Registered Association, Berlin, Germany
| | | | | | - Kathrin Pahmeier
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
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How has the cost of antiretroviral therapy changed over the years? A database analysis in Italy. BMC Health Serv Res 2018; 18:691. [PMID: 30189882 PMCID: PMC6127985 DOI: 10.1186/s12913-018-3507-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/29/2018] [Indexed: 12/24/2022] Open
Abstract
Background The number of human immunodeficiency virus (HIV)-related hospitalizations has decreased worldwide in recent years, due to the availability of combined antiretroviral therapies (cART). The present analysis aimed to analyse the economic, and clinical burden of HIV management, after the introduction of systematic use of cART. Methods Data from HIV-infected patients, treated at Policlinico San Martino Hospital in Genova (Italy) were retrospectively collected. A comparison between years 2009 and 2015 was performed. HIV-related admissions were identified by using the Diagnosis-Related Group (DRG) codes. The resource consumption of outpatient services was derived by using a modelling approach. Expenditure for drugs was also analysed, as aggregate data. Results The number of HIV-infected patients was 898 in 2009 and 1006 in 2015. Overall, the virological success rate improved from 2009 to 2015, as the percentage of patients with HIV-RNA < 50 copies/mL increased from 79 to 89% (P < 0.05). The average incidence of hospitalizations per-patient decreased from 0.30 in 2009, to 0.13 in 2015. Average expenditure per-patient decreased from €10,107 in 2009 to €9063 in 2015. Conclusions The present analysis confirmed the role of cART in controlling HIV viral load and, consequently, in reducing hospitalizations, admissions to day-hospital and the use of outpatient services. Clinical improvements and economic savings more than compensated the investments required to treat HIV-infected patients with cART. Health Authorities should invest in modern cART supply and universal treatment, to use at best the available resources and obtain a cost-effective improvement of health in people living with HIV. Additional research, with the involvement of different centers and the use of patient-specific data, are recommended to consolidate the findings of this analysis. Electronic supplementary material The online version of this article (10.1186/s12913-018-3507-x) contains supplementary material, which is available to authorized users.
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Quiros-Roldan E, Magoni M, Raffetti E, Donato F, Scarcella C, Paraninfo G, Castelli F. The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population. BMC Public Health 2016; 16:1146. [PMID: 27829390 PMCID: PMC5103392 DOI: 10.1186/s12889-016-3804-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background The increase in life expectancy of HIV-infected patients has driven increased costs due to life-long HIV treatment and concurrent age-related comorbidities. This population-based study aimed to investigate the burden of chronic diseases and health costs for HIV+ subjects compared to the general population living in Brescia Local health Agency (LHA) over a 12-year period. Methods LHA database recorded diagnoses, deaths, drug prescriptions and health resource utilization for all residents during 2003–2014. We estimated HIV prevalence and incidence, HIV-related mortality as well as prevalence of chronic diseases in HIV+ subjects. Observed/expected ratio of chronic diseases was calculated by indirect standardization with the general population as reference. Direct cost of HIV care and determinants were estimates across the period. Results HIV prevalence increased from 220 to 307 per 100 000 person-years while incidence decreased from 16.1 to 10.8 per 100 000 person-years from 2003 to 2014. Prevalence of most comorbidities increased over time but it reduced significantly (annual mean change − 0.7 %) when adjusting for age and gender. Observed to expected ratio for each chronic disease in HIV+ subjects decreased over time. Cost of HIV+ cures increased (+25 %) mainly due to cost for drugs (+50 %) but it stabilized in recent years. CD4+ cell count at the time of diagnosis was an important predictor of cost for HIV management. Conclusions Expenditures for HIV-infection are driven mainly by drugs cost and they have increased overtime. However, our findings suggest that spending on public health for HIV care can improve prognosis of HIV-infected patients, reduce transmission of HIV infection and reduce the global burden of chronic diseases, leading to a reduction of HIV global cost in the medium-long time. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3804-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eugenia Quiros-Roldan
- University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Michele Magoni
- Local Health Agency of the Brescia Province, Viale Duca degli Abruzzi 15, 25124, Brescia, Italy
| | - Elena Raffetti
- Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | - Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Carmelo Scarcella
- Local Health Agency of the Brescia Province, Viale Duca degli Abruzzi 15, 25124, Brescia, Italy
| | - Giuseppe Paraninfo
- University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Di Biagio A, Riccardi N, Taramasso L, Capetti A, Cenderello G, Signori A, Vitiello P, Guerra M, de Socio GV, Cassola G, Quirino T, Viscoli C. Switch from unboosted protease inhibitor to a single-tablet regimen containing rilpivirine improves cholesterol and triglycerides. Int J Antimicrob Agents 2016; 48:551-554. [PMID: 27566908 DOI: 10.1016/j.ijantimicag.2016.07.009] [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: 05/24/2016] [Revised: 07/11/2016] [Accepted: 07/15/2016] [Indexed: 01/11/2023]
Abstract
This study aimed to evaluate the efficacy, tolerability and potential savings of combined antiretroviral therapy (cART) simplification from an unboosted protease inhibitor (PI) regimen with atazanavir or fosamprenavir to a single-tablet regimen (STR) based on rilpivirine/emtricitabine/tenofovir disoproxil fumarate (RPV/FTC/TDF) among HIV-1-infected patients with HIV-1 RNA <50 copies/mL. This was a retrospective, multicentre, open-label, 12-week trial. Plasma HIV-1-RNA levels, CD4+ cell counts, cholesterol, triglycerides, bilirubin, glycaemia, creatinine and physical examination were performed at baseline and at scheduled follow-up. All patient costs were calculated and were estimated for 52 weeks of therapy. Fifty-one patients were enrolled [28 male (54.9%)]. At baseline, 30 patients (58.8%) were treated with FTC/TDF, 20 (39.2%) with abacavir/lamivudine and 1 (2.0%) with lamivudine/zidovudine. Thirty-three patients (64.7%) received atazanavir. All patients maintained HIV-RNA <50 copies/mL; the median CD4+ cell count remained stable. Mean triglycerides decreased from 124 mg/dL (range, 39-625) at enrolment to 108.7 mg/dL (range, 39-561) at study end (P = 0.25). At baseline, mean cholesterol was 172.8 ± 38.1 mg/dL and decreased to 161.9 ± 38.6 mg/dL (P = 0.038); likewise, median total bilirubin decreased from 1.07 mg/dL (range, 0.2-4.7) to 0.6 mg/dL (range, 0.13-3.1) (P <0.001). cART-related annual cost reduction with a STR was €3155.47 per patient (-24%). Non-cART patient management expenses were €402.68 vs. €299.10 for atazanavir or fosamprenavir and STR regimens, respectively. Switching to RPV/FTC/TDF from an unboosted PI in virologically suppressed HIV-infected patients is safe and is associated with a reduction in triglycerides, cholesterol and cART-related costs.
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Affiliation(s)
- Antonio Di Biagio
- Infectious Diseases Clinic, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University of Genoa, L.go Rosanna Benzi 10, Genoa 16132, Italy
| | - Niccolò Riccardi
- Infectious Diseases Clinic, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University of Genoa, L.go Rosanna Benzi 10, Genoa 16132, Italy.
| | - Lucia Taramasso
- Infectious Diseases Clinic, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University of Genoa, L.go Rosanna Benzi 10, Genoa 16132, Italy
| | - Amedeo Capetti
- Infectious Diseases Unit, Ospedale Luigi Sacco, Milan, Italy
| | | | - Alessio Signori
- Department of Health Science, Biostatistics, University of Genoa, Genoa, Italy
| | - Paola Vitiello
- Infectious Diseases Unit, Ospedali di Busto Arsizio, Varese, Italy
| | | | - Giuseppe Vittorio de Socio
- Infectious Diseases Unit, Ospedale di Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | | | - Tiziano Quirino
- Infectious Diseases Unit, Ospedali di Busto Arsizio, Varese, Italy
| | - Claudio Viscoli
- Infectious Diseases Clinic, IRCCS AOU San Martino-IST, National Institute for Cancer Research, University of Genoa, L.go Rosanna Benzi 10, Genoa 16132, Italy
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