Tontodonati Monica, Cenderello Giovanni, Celesia Benedetto Maurizio, Trezzi Michele, Ursini Tamara, Costantini Andrea, Marra Domenico, Polilli Ennio, Catalani Corrado, Butini Luca, Sozio Federica, Mazzotta Elena, Sciacca Antonina, Rizzardini Giuliano, Manzoli Lamberto, Cozzi-Lepri Alessandro, Parruti Giustino
Infectious Disease Unit, Pescara General Hospital, Pescara, Italy ; Clinic of Infectious Diseases, G D'Annunzio University of Chieti-Pescara, Chieti, Italy.
Division of Infectious Disease, Galliera General Hospital, Genoa, Italy.
Clinicoecon Outcomes Res. 2014 Dec 22;7:27-35. doi: 10.2147/CEOR.S69183. eCollection 2015.
As HIV infection turned into a chronic treatable disease, now ranking as one of the most costly in medicine, long-term sustainability of highly active antiretroviral treatment (HAART) expenses became a major issue, especially in countries with universal access to care. Identification of determinants of higher HAART costs may therefore help in controlling costs of care, while keeping high levels of retention in care and viral suppression.
With this aim, we enrolled a large multicentric sample of consecutive unselected human immunodeficiency virus (HIV) patients followed at five sites of care in Italy, and evaluated annual individual HAART costs in relation to a number of sociodemographic, clinical, and laboratory variables.
We enrolled 2,044 patients, including 1,902 on HAART. Mean HAART costs were €9,377±€3,501 (range 782-29,852) per year, with remarkable site-based differences, possibly related to the different composition of local assisted populations. Percentages of patients on viral suppression were homogeneously high across all study sites. The factors identified by cross-validation were line of HAART, diagnosis of acquired immune deficiency syndrome, current CD4 T-cell count, and detectable HIV viremia >50 copies/mL. In the final multivariable model, HAART costs were independently directly associated with more advanced HAART line (P<0.001) and inversely correlated with current CD4 T-cell count (P=0.024). Site of care held independent prediction of higher costs, with marked control of expenses at sites 2 (P=0.001) and 5 (P<0.001).
Higher costs of HAART were strongly associated with previous treatment failures, detectable HIV viremia, and lower CD4 T-cell count at the time of evaluation, with no correlation at all with sex, age, hepatitis C virus coinfection, and nadir CD4 T-cell counts. Newer drugs, which are typically those associated with high prices, at the time of the analysis were still prevalently prescribed to rescue and maintain viral suppression in patients with more complex treatment history. Further analyses of the contribution of the single drug/regimen to the estimated cost are warranted.
随着艾滋病毒感染转变为一种可慢性治疗的疾病，如今已成为医疗费用最高的疾病之一，高效抗逆转录病毒治疗（HAART）费用的长期可持续性成为一个主要问题，尤其是在全民可获得医疗服务的国家。因此，确定HAART费用较高的决定因素可能有助于控制医疗费用，同时保持较高的治疗留存率和病毒抑制水平。
出于这一目的，我们在意大利的五个医疗点纳入了一个大型多中心连续未筛选的人类免疫缺陷病毒（HIV）患者样本，并评估了与一些社会人口统计学、临床和实验室变量相关的年度个人HAART费用。
我们纳入了2044名患者，其中1902名接受HAART治疗。HAART的平均费用为每年9377±3501欧元（范围782 - 29852欧元），各医疗点存在显著差异，这可能与当地受助人群的不同构成有关。所有研究点病毒抑制患者的百分比均普遍较高。通过交叉验证确定的因素包括HAART治疗方案、获得性免疫缺陷综合征的诊断、当前CD4 T细胞计数以及可检测到的HIV病毒血症>50拷贝/毫升。在最终的多变量模型中，HAART费用与更高级别的HAART治疗方案直接独立相关（P<0.001），与当前CD4 T细胞计数呈负相关（P = 0.024）。医疗点对更高费用具有独立预测作用，第2个医疗点（P = 0.001）和第5个医疗点（P<0.001）的费用得到显著控制。
HAART费用较高与既往治疗失败、可检测到的HIV病毒血症以及评估时较低的CD4 T细胞计数密切相关，与性别、年龄、丙型肝炎病毒合并感染以及最低CD4 T细胞计数完全无关。在分析时，通常与高价格相关的新药仍普遍用于治疗病史更复杂的患者以挽救并维持病毒抑制。有必要进一步分析单一药物/治疗方案对估计费用的贡献。
