高效抗逆转录病毒疗法对HIV感染患者的成本效益。瑞士HIV队列研究。

Cost effectiveness of highly active antiretroviral therapy in HIV-infected patients. Swiss HIV Cohort Study.

作者信息

Sendi P P, Bucher H C, Harr T, Craig B A, Schwietert M, Pfluger D, Gafni A, Battegay M

机构信息

Internal Medicine Outpatient Department, University of Basel, Switzerland.

出版信息

AIDS. 1999 Jun 18;13(9):1115-22. doi: 10.1097/00002030-199906180-00016.

DOI:10.1097/00002030-199906180-00016

PMID:10397543

Abstract

BACKGROUND

Highly active antiretroviral therapy (HAART) has become the most important strategy for treating HIV infection in developed countries; however, access to HAART might vary under different funding policies. The Swiss health care system provides unrestricted access to HAART for all patients who need these newer combination therapies. This study investigated the impact of this funding policy on the society and health care system.

METHODS

A cost-effectiveness analysis with natural history data and productivity estimates was based on the Swiss HIV Cohort Study. A random sample of patient charts was used to estimate health care costs. In addition to a base-case scenario, a pessimistic and an optimistic scenario of natural disease history was developed. Costs were expressed in 1997 Swiss francs (100 CHF correspond to about US$67) and effects as projected years of life gained.

RESULTS

In the analysis limited to health care costs, on the basis of projected survival in each scenario, the cost-effectiveness ratio was 33,000 CHF (base case), 14,000 CHF (optimistic), and 45,000 CHF (pessimistic) per year of life gained. When changes in productivity were included, cost savings occurred in the base-case and optimistic scenarios. The cost-effectiveness ratio was 11,000 CHF per year of life gained in the pessimistic scenario.

CONCLUSIONS

HAART increases expected survival and health care costs. However, when productivity gains are included, society will probably save costs or pay a low price for substantial health benefits. The study provides strong arguments, from a societal perspective, to continue the current policy of providing unrestricted access to HAART in Switzerland. The presented results also suggest that this policy could be of interest for other developed countries. Decision makers in developed countries where access to HAART is limited should re-evaluate their policy for the benefit of the society at large.

摘要

背景

高效抗逆转录病毒疗法（HAART）已成为发达国家治疗HIV感染的最重要策略；然而，在不同的资助政策下，获得HAART的机会可能会有所不同。瑞士医疗保健系统为所有需要这些新型联合疗法的患者提供不受限制的HAART治疗。本研究调查了这一资助政策对社会和医疗保健系统的影响。

方法

基于瑞士HIV队列研究，采用自然病史数据和生产力估计进行成本效益分析。使用患者病历的随机样本估计医疗保健成本。除了基础情景外，还制定了自然疾病史的悲观情景和乐观情景。成本以1997年瑞士法郎表示（100瑞士法郎约合67美元），效果以预期获得的生命年数表示。

结果

在仅限于医疗保健成本的分析中，根据每种情景下的预期生存率，每获得一年生命的成本效益比为33,000瑞士法郎（基础情景）、14,000瑞士法郎（乐观情景）和45,000瑞士法郎（悲观情景）。当纳入生产力变化时，基础情景和乐观情景下出现了成本节约。悲观情景下每获得一年生命的成本效益比为11,000瑞士法郎。

结论

HAART提高了预期生存率和医疗保健成本。然而，当纳入生产力提高因素时，社会可能会节省成本或为巨大的健康益处付出较低代价。从社会角度来看，该研究提供了有力论据，支持瑞士继续实施目前不受限制地提供HAART的政策。所呈现的结果还表明，这一政策可能对其他发达国家具有借鉴意义。在HAART获取受限的发达国家，决策者应为了整个社会的利益重新评估其政策。