Nakagawa Fumiyo, Miners Alec, Smith Colette J, Simmons Ruth, Lodwick Rebecca K, Cambiano Valentina, Lundgren Jens D, Delpech Valerie, Phillips Andrew N
Research Department of Infection and Population Health, UCL, London, United Kingdom.
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS One. 2015 Apr 22;10(4):e0125018. doi: 10.1371/journal.pone.0125018. eCollection 2015.
Estimates of healthcare costs associated with HIV infection would provide valuable insight for evaluating the cost-effectiveness of possible prevention interventions. We evaluate the additional lifetime healthcare cost incurred due to living with HIV.
We used a stochastic computer simulation model to project the distribution of lifetime outcomes and costs of men-who-have-sex-with-men (MSM) infected with HIV in 2013 aged 30, over 10,000 simulations. We assumed a resource-rich setting with no loss to follow-up, and that standards and costs of healthcare management remain as now.
Based on a median (interquartile range) life expectancy of 71.5 (45.0-81.5) years for MSM in such a setting, the estimated mean lifetime cost of treating one person was £ 360,800 ($567,000 or € 480,000). With 3.5% discounting, it was £ 185,200 ($291,000 or € 246,000). The largest proportion (68%) of these costs was attributed to antiretroviral drugs. If patented drugs are replaced by generic versions (at 20% cost of patented prices), estimated mean lifetime costs reduced to £ 179,000 ($ 281,000 or € 238,000) and £ 101,200 ($ 158,900 or € 134,600) discounted.
If 3,000 MSM had been infected in 2013, then future lifetime costs relating to HIV care is likely to be in excess of £ 1 billion. It is imperative for investment into prevention programmes to be continued or scaled-up in settings with good access to HIV care services. Costs would be reduced considerably with use of generic antiretroviral drugs.
估算与艾滋病毒感染相关的医疗保健成本，可为评估可能的预防干预措施的成本效益提供有价值的见解。我们评估了感染艾滋病毒后一生中额外产生的医疗保健成本。
我们使用一个随机计算机模拟模型，对2013年30岁的男男性行为者（MSM）感染艾滋病毒后的终生结局和成本分布进行了超过10000次模拟。我们假设处于资源丰富的环境，无失访情况，且医疗管理标准和成本保持不变。
在这种环境下，MSM的中位（四分位间距）预期寿命为71.5（45.0 - 81.5）岁，治疗一人的估计终生平均成本为360,800英镑（567,000美元或480,000欧元）。按3.5%的贴现率计算，为185,200英镑（291,000美元或246,000欧元）。这些成本中最大的比例（68%）归因于抗逆转录病毒药物。如果专利药物被通用版本取代（成本为专利价格的20%），估计终生平均成本降至179,000英镑（281,000美元或238,000欧元），贴现后为101,200英镑（158,900美元或134,600欧元）。
如果2013年有3000名MSM感染艾滋病毒，那么未来与艾滋病毒护理相关的终生成本可能超过10亿英镑。在能够良好获取艾滋病毒护理服务的地区，继续或扩大对预防项目的投资至关重要。使用通用抗逆转录病毒药物可大幅降低成本。
