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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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Lottes M, Bremer V, Prugger C, Kollan C, Schmidt D. Cost-savings and potential cost-savings through the distribution of generic antiretroviral drugs within the statutory health insurance market of Germany between January 2017 and June 2019. BMC Health Serv Res 2022; 22:63. [PMID: 35027062 PMCID: PMC8756633 DOI: 10.1186/s12913-021-07390-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract Background Recent patent losses for antiretroviral drugs (ARV) have led to the debate of cost-saving through the replacement of patented drugs with generic drugs. The split of recommended single-tablet regimens (STR) into their single substance partners is one of the considerations mentioned in said debate. Particularly, generic tenofovir disoproxil/emtricitabine (TDF/FTC) is expected to hold untapped cost-saving potential, which may curb increasing overall expenditures for combined antiretroviral therapy (cART) within the statutory health insurance (SHI) of Germany. Methods Data of ARV reimbursed by the SHI were used to describe the trends of defined daily doses (DDD) as well as the revenue within the German ARV market. They were also used to determine the cost-savings of moving to generic drugs. The time period observed was between January 2017 and June 2019. The potential cost-savings were determined with following assumption in mind: the maximum possible use of generic ARV, including 1) the split of STR and replacing all substance partners with generic ones, and 2) replacing patented tenofovir alafenamide/emtricitabine (TAF/FTC) with generic TDF/FTC. Results Throughout the observation period, the DDD of generic ARV increased nearly five-fold while their revenue increased more than four-fold. Total cost-saving showed a sharp increase over the same period, with generic TDF/FTC accounting for a share of around 70%. The largest potential cost-saving could have been achieved through replacing patented TAF/FTC with generic TDF/FTC, peaking at nearly 10% of total revenue, but showing decreasing trends in general. Conclusion The progressive distribution of generic ARV ensured increasing cost-savings, but consequently curbed the potential cost-savings. Unique price reductions of generic TDF/FTC have played a pivotal role for these effects. In any case, substituting with generic ARV should not fail to adhere to the treatment guidelines and continue to consider the medical requirements for the treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07390-4.
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Abstract
We aimed to identify "high-cost" patients with HIV (PWH) and determine drivers behind higher costs. All PWH at the Southern Alberta HIV Clinic, Canada, and active in 2017 were included. Sociodemographic, clinical, and healthcare utilization data were collected. The direct care costs from the payers' perspective including antiretroviral drugs (ARV), outpatient visits, and hospital admissions were determined for 2017. Patients' annual total costs were grouped into top 5% (i.e., high-cost), top 20%, middle 60%, and bottom 20%. High-cost patients were older, Caucasian or indigenous Canadian, and more likely acquired HIV from intravenous drug use (all p < 0.05). High-cost patients had lower nadir CD4, more comorbidities, missed more clinic appointments, had more ARV interruptions, and developed more ARV resistance (p < 0.01). The overall median cost of HIV care was US$14,064 [IQR US$13,121-US$17,883] (2017 Cdn$). High-cost patients had a median cost of US$29,902 [IQR US$27,229-US$37,891] and accounted for 14% of total costs and 84% of all inpatient costs. Hospitalizations constituted 58% of costs for high-cost patients. Although heterogeneous, high-cost patients have distinct sociodemographic and clinical characteristics driving their healthcare utilization. Addressing these social determinants of health and using novel ARV administration approaches may preserve health and save costs.
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Affiliation(s)
- Hartmut B Krentz
- Southern Alberta Clinic, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - M John Gill
- Southern Alberta Clinic, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
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Achieving HIV targets by 2030: the possibility of using debt relief funds for sustainable HIV treatment in sub-Saharan Africa. J Public Health Policy 2020; 41:421-435. [PMID: 32747703 PMCID: PMC7396728 DOI: 10.1057/s41271-020-00238-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper assesses the possibility of using debt relief funds to sustain HIV treatment in sub-Saharan Africa, suppress transmission, and reach global goals to quell the epidemic by 2030. The cost of providing antiretroviral treatment is a huge burden on African countries. Concerns for Africa's capacity to keep pace with global advances are well founded. By analysing levels of 'debt distress', health expenditure per capita, and HIV antiretroviral therapy requirements in sub-Saharan African countries, the need for innovative finance with international cooperation emerges clearly. In addition to the HIV epidemic, African countries may become more vulnerable to disasters and other public health diseases such as malaria, tuberculosis, Ebola and COVID-19, especially without alternatives to current means of financing. Relief from debt service payments could release funds for sub-Saharan African countries to support universal HIV antiretroviral treatment with sustainable results.
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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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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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Enns B, Min JE, Panagiotoglou D, Montaner JSG, Nosyk B. Geographic variation in the costs of medical care for people living with HIV in British Columbia, Canada. BMC Health Serv Res 2019; 19:626. [PMID: 31481056 PMCID: PMC6724338 DOI: 10.1186/s12913-019-4391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/01/2019] [Indexed: 12/04/2022] Open
Abstract
Background Regional variation in medical care costs can indicate heterogeneity in clinical practice, inequities in access, or inefficiencies in service delivery. We aimed to estimate regional variation in medical costs for people living with HIV (PLHIV), adjusting for demographics and case-mix. Methods We conducted a retrospective cohort study using linked health administrative databases of PLHIV, from 2010 to 2014, in British Columbia (BC), Canada. Quarterly health care costs (2018 CAD) were derived from inpatient, outpatient, prescription drugs, antiretroviral therapy (ART), and HIV diagnostics. We used a two-part model with a logit link for the probability of incurring costs, and a log link and gamma distribution for observations with positive costs. We also estimated quarterly utilization rates for hospitalization-, physician billing- and prescription drug-days. Primary variables were indicators of individuals’ Health Service Delivery Area (HSDA). We adjusted cost and utilization estimates for demographic characteristics, HIV-disease progression, and comorbidities. Results Our cohort included 9577 PLHIV (median age 45.5 years, 80% male). Adjusted total quarterly costs for all 16 HSDAs were within 20% of the provincial mean, 8/16 for hospitalization costs, 16/16 for physician billing costs and 10/16 for prescription drug costs. Northern Interior and Northeast HSDAs had 38 and 44% lower quarterly non-ART prescription drug costs, and 2 and 5% higher quarterly inpatient costs, respectively. Conclusions We observed limited variation in medical care costs and utilization among PLHIV in BC. However, lower levels of outpatient care and higher levels of inpatient care indicate possible barriers to accessing care among PLHIV in the most rural regions of the province. Electronic supplementary material The online version of this article (10.1186/s12913-019-4391-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Enns
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Jeong Eun Min
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Dimitra Panagiotoglou
- Faculty of Medicine, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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Kasaie P, Radford M, Kapoor S, Jung Y, Hernandez Novoa B, Dowdy D, Shah M. Economic and epidemiologic impact of guidelines for early ART initiation irrespective of CD4 count in Spain. PLoS One 2018; 13:e0206755. [PMID: 30395635 PMCID: PMC6218062 DOI: 10.1371/journal.pone.0206755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/18/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Emerging data suggest that early antiretroviral therapy (ART) could reduce serious AIDS and non-AIDS events and deaths but could also increase costs. In January 2016, the Spanish guidelines were updated to recommend ART at any CD4 count. However, the epidemiologic and economic impacts of early ART initiation in Spain remain unclear. METHODS The Johns Hopkins HIV Economic-Epidemiologic Mathematical Model (JHEEM) was utilized to estimate costs, transmissions, and outcomes in Spain over 20 years. We compared implementation of guidelines for early ART initiation to a counterfactual scenario deferring ART until CD4-counts fall below 350 cells/mm3. We additionally studied the impact of early ART initiation in combination with improvements to HIV screening, care linkage and engagement. RESULTS Early ART initiation (irrespective of CD4-count) is expected to avert 20,100 [95% Uncertainty Range (UR) 11,100-83,000] new HIV cases over the next two decades compared to delayed ART (28% reduction), at an incremental health system cost of €1.05 billion [€0.66 - €1.63] billion, and an incremental cost-effectiveness ratio (ICER) of €29,700 [€13,700 - €41,200] per QALY gained. Projected ICERs declined further over longer time horizon; e.g., an ICER of €12,691 over 30 years. Furthermore, the impact of early ART initiation was potentiated by improved HIV screening among high-risk individuals, averting an estimated 41,600 [23,200-172,200] HIV infections (a 58% decline) compared to delayed ART. CONCLUSIONS Recommendations for ART initiation irrespective of CD4-counts are cost-effective and could avert > 30% of new cases in Spain. Improving HIV diagnosis can amplify this impact.
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Affiliation(s)
- Parastu Kasaie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Sunaina Kapoor
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Younghee Jung
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - David Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maunank Shah
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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Krentz HB, John Gill M. Long-term HIV/AIDS survivors: Patients living with HIV infection retained in care for over 20 years. What have we learned? Int J STD AIDS 2018; 29:1098-1105. [PMID: 29933720 DOI: 10.1177/0956462418778705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals diagnosed with HIV before 1996 had poor prognoses. Few HIV care centers can track patients continuously from the 1980s to present. We determined the sociodemographic, clinical, and health care utilization characteristics of patients diagnosed and followed for >20 years (i.e. long-term HIV/AIDS survivors) to understand what factors contributed to survival. All HIV-positive patients diagnosed before 1996 were categorized as active, moved/lost, or died as of 1 January 2016. Baseline sociodemographic, clinical characteristics, antiretroviral therapy (ART) usage, retention, HIV care costs, and health status were analyzed. Of 876 patients, 49.5% died, 30.3% moved or left, 20.3% remained active in care for a median of 23.4 years. At diagnosis, continuously-followed patients were younger with a higher CD4 cell count, attended regular clinic visits at higher frequencies, and had received more ART than patients who moved or died. As of 1 January 2016, their median age was 57 years (interquartile range 53-62), 15% were aged >65 years, median CD4 cell count was 591 cells/mm3 (475-863) with 68% >500 cells/mm3. Sixty-two percent remained employed. The total cost of HIV care was $32,251,030 (Cdn$); median cost per patient per year $15,418 ($13,697-$18,392). Individuals diagnosed prior to 1996 benefited from early diagnosis and engagement to care, regular follow-ups, and timely initiation of ART, strongly supporting the modern guidelines of care.
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Affiliation(s)
- Hartmut B Krentz
- 1 Southern Alberta Clinic, Calgary, Canada.,2 Department of Medicine, University of Calgary, Calgary, Canada
| | - M John Gill
- 1 Southern Alberta Clinic, Calgary, Canada.,2 Department of Medicine, University of Calgary, Calgary, Canada
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Mahlich J, Groß M, Kuhlmann A, Bogner J, Heiken H, Stoll M. The choice between a ritonavir-boosted protease inhibitor- and a non-nucleoside reverse transcriptase inhibitor-based regimen for initiation of antiretroviral treatment - results from an observational study in Germany. J Pharm Policy Pract 2016; 9:39. [PMID: 28050254 PMCID: PMC5203724 DOI: 10.1186/s40545-016-0092-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study aims at identifying predictors of the treatment decision of German physicians with regard to a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r) -based initial treatment regimen. METHODS The study is based on a sub analysis of a nation-wide multi-centre, non-interventional, prospective cohort study. 133 patients were identified, who received antiretroviral first-line therapy. By means of a logistic regression, factors that determine the treatment strategy for treatment-naïve patients were analysed. RESULTS Compared to patients receiving a NNRTI-based initial regimen, patients treated with PI/r are slightly younger, less educated, in a later stage of HIV and have more concomitant diseases. Regression analysis revealed that being in a later stage of HIV (CDC-C) is significantly associated with a PI/r-based treatment decision. CONCLUSIONS Our analysis is the first study in Germany investigating sociodemographic and disease-specific parameters associated with a NNRTI- or a PI/r-based initial treatment decision. The results confirm that the treatment decision for a PI/r strategy is associated with disease severity.
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Affiliation(s)
- Jörg Mahlich
- Janssen KK, Health Economics, Tokyo, Japan ; Heinrich-Heine University of Düsseldorf, Düsseldorf Institute for Competition Economics (DICE), Düsseldorf, Germany
| | - Mona Groß
- Heinrich-Heine University of Düsseldorf, Düsseldorf Institute for Competition Economics (DICE), Düsseldorf, Germany
| | - Alexander Kuhlmann
- University of Hanover, Centre for Health Economics Research, Hanover, Germany
| | - Johannes Bogner
- Division of Infectious Diseases, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Matthias Stoll
- Hannover Medical School (MHH), Centre for Internal Medicine, Hanover, Germany
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