Restelli Umberto, Andreoni Massimo, Antinori Andrea, Bonfanti Marzia, Di Perri Giovanni, Galli Massimo, Lazzarin Adriano, Rizzardini Giuliano, Croce Davide
Department of Community Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; Centro di Ricerca in Economia e Management in Sanità e nel Sociale (CREMS), Università Carlo Cattaneo - LIUC, Castellanza (VA), Italy.
Clinical Infectious Diseases, Tor Vergata University (PTV), Rome, Italy.
Clinicoecon Outcomes Res. 2014 Sep 23;6:409-14. doi: 10.2147/CEOR.S68101. eCollection 2014.
Deintensification and less drug regimen (LDR) antiretroviral therapy (ART) strategies have proved to be effective in terms of maintaining viral suppression in human immunodeficiency virus (HIV)-positive patients, increasing tolerability, and reducing toxicity of antiretroviral drugs administered to patients. However, the economic impact of these strategies have not been widely investigated. The aim of the study is to evaluate the economic impact that ART LDR could have on the Italian National Health Service (INHS) budget.
A budget impact model was structured to assess the potential savings for the INHS by the use of ART LDR for HIV-positive patients with a 3 year perspective. Data concerning ART cost, patient distribution within different ARTs, and probabilities for patients to change ART on a yearly basis were collected within four Italian infectious diseases departments, providing ART to 13.7% of the total number of patients receiving ART in Italy.
The LDR investigated (protease inhibitor-based dual and monotherapies) led to savings for the hospitals involved when compared to the "do nothing" scenario on a 3 year basis, between 6.7% (23.11 million €) and 12.8% (44.32 million €) of the total ART expenditures. The mean yearly cost per patient is reduced from 9,875 € in the do nothing scenario to a range between 9,218 € and 8,615 €. The use of these strategies within the four departments involved would have led to a reduction of ART expenditures for the INHS of between 1.1% and 2.1% in 3 years.
ART LDR simplification would have a significant impact in the reduction of ART-related costs within the hospitals involved in the study. These strategies could therefore be addressed as a sustainable answer to the public financing reduction observed within the INHS in the last year, allowing therapies to be dispensed without affecting the quality of the services provided.
简化和低剂量药物方案（LDR）抗逆转录病毒疗法（ART）策略已被证明在维持人类免疫缺陷病毒（HIV）阳性患者的病毒抑制、提高耐受性以及降低给予患者的抗逆转录病毒药物毒性方面是有效的。然而，这些策略的经济影响尚未得到广泛研究。本研究的目的是评估ART LDR对意大利国家卫生服务局（INHS）预算可能产生的经济影响。
构建了一个预算影响模型，以评估使用ART LDR为HIV阳性患者带来的潜在节省，为期3年。在意大利四个传染病科室收集了有关ART成本、不同ART方案下患者分布以及患者每年更换ART方案的概率的数据，这些科室为意大利接受ART治疗患者总数的13.7%提供治疗。
与“不采取任何措施”的情况相比，所研究的LDR（基于蛋白酶抑制剂的双联和单药疗法）在3年的时间里为相关医院节省了费用，占ART总支出的6.7%（2311万欧元）至12.8%（4432万欧元）。每位患者的年均成本从“不采取任何措施”情况下的9875欧元降至9218欧元至8615欧元之间。在涉及的四个科室采用这些策略将使INHS在3年内的ART支出减少1.1%至2.1%。
ART LDR简化将对参与研究的医院内与ART相关的成本降低产生重大影响。因此，这些策略可被视为对去年INHS中观察到的公共资金减少的可持续应对措施，能够在不影响所提供服务质量的情况下提供治疗。
