Health Economics and Epidemiology Research Office, Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa.
AIDS. 2010 Mar 27;24(6):915-9. doi: 10.1097/QAD.0b013e3283360976.
The present article estimates the cost and outcomes of second-line antiretroviral therapy. The cost of second-line drugs is generally higher than that of first-line drugs and it is expected that the absolute number of patients on second-line antiretroviral therapy will increase over time. This information is crucial for planning and budgeting.
Resource utilization and outcome data were extracted for patients who initiated standard second-line therapy. Resource usage was measured from second-line initiation for 12 months and outcomes were determined at 12 months. Unit costs were applied to resource usage using standard costing techniques. Costs were classified into drug, laboratory, visit, and fixed costs. Outcomes at 12 months were determined using attendance status, diagnostic results, and treatment status. Average cost per patient and average cost per outcome were reported.
Of the 293 participants in the study cohort, 58% remained in care and responding, 15% were in care but not responding, and 26% were no longer in care. During the 12 months following second-line initiation, the average cost per participant was $1037. Most of the cost per patient was attributable to drugs (71%), 13% to laboratory tests, 10% to clinic and pharmacy visits, and 6% to infrastructure and other fixed costs. Second-line therapy was 2.4 times more expensive per year in care than first-line therapy.
The gradual increase in second-line numbers that can be expected as treatment programs mature may cause a meaningful increase in the overall average cost per patient treated.
本文旨在评估二线抗逆转录病毒治疗的成本和结果。二线药物的成本通常高于一线药物，预计随着时间的推移，接受二线抗逆转录病毒治疗的患者绝对数量将会增加。这些信息对于规划和预算至关重要。
提取接受标准二线治疗的患者的资源利用和结果数据。资源使用情况从二线治疗开始的 12 个月内进行测量，结果在 12 个月时确定。使用标准成本核算技术将单位成本应用于资源使用。成本分为药物、实验室、就诊和固定成本。12 个月时的结果通过就诊情况、诊断结果和治疗状况来确定。报告每位患者的平均成本和每个结果的平均成本。
在研究队列的 293 名参与者中，58%的人仍在接受护理和治疗，15%的人在接受护理但未应答，26%的人不再接受护理。在二线治疗开始后的 12 个月内，每位参与者的平均费用为 1037 美元。每位患者的大部分费用归因于药物（71%），13%归因于实验室检查，10%归因于诊所和药房就诊，6%归因于基础设施和其他固定成本。二线治疗的年费用比一线治疗高出 2.4 倍。
随着治疗计划的成熟，二线治疗数量的逐渐增加可能会导致每位治疗患者的总体平均费用显著增加。
