国家艾滋病药物援助政策对艾滋病毒感染者临床和经济结果的影响。
The Impact of State AIDS Drug Assistance Policies on Clinical and Economic Outcomes of People With HIV.
作者信息
Snider Julia Thornton, Goldman Dana P, Rosenblatt Lisa, Seekins Daniel, Juday Timothy, Sanchez Yuri, Wu Yanyu, Peneva Desi, Romley John A
机构信息
Precision Health Economics, Los Angeles, CA, USA
University of Southern California, Los Angeles, CA, USA.
出版信息
Med Care Res Rev. 2016 Jun;73(3):329-48. doi: 10.1177/1077558715614479. Epub 2015 Nov 3.
We investigated the effect of changes to state AIDS Drug Assistance Programs (ADAP) policies, which govern access to antiretroviral therapy (ART), on clinical and economic outcomes among low-income people living with HIV/AIDS. Retrospective analyses of ART access were conducted on state ADAP policies, using data from ADAP Monitoring Reports and Kaiser Family Foundation from 2006 to 2010. We found stricter eligibility requirements reduce the number of HIV-positive individuals with ART access through ADAP, and decreased ART use increases mortality by 2.67 quality-adjusted life years (QALYs) per beneficiary. If the ADAP income eligibility cutoff were decreased by 50 percentage points in each state, 4,626 individuals would lose ART access nationwide. Based on a $22,143 cost/QALY, this policy would save $274 million in health care expenditures (2012 dollars), but result in 12,352 QALYs lost, valued at $1.2 billion. Therefore, states should exercise caution in restricting programs that increase ART access for low-income people living with HIV/AIDS.
我们调查了州艾滋病药物援助计划（ADAP）政策的变化对低收入艾滋病毒/艾滋病感染者的临床和经济结果的影响，该政策规定了抗逆转录病毒疗法（ART）的获取途径。利用2006年至2010年ADAP监测报告和凯撒家庭基金会的数据，对州ADAP政策进行了抗逆转录病毒疗法获取情况的回顾性分析。我们发现，更严格的资格要求减少了通过ADAP获得抗逆转录病毒疗法的艾滋病毒阳性个体数量，而抗逆转录病毒疗法使用的减少使每位受益人的死亡率增加了2.67个质量调整生命年（QALY）。如果每个州的ADAP收入资格门槛降低50个百分点，全国将有4626人失去获得抗逆转录病毒疗法的机会。按照每QALY成本22143美元计算，这项政策将节省2.74亿美元的医疗保健支出（2012年美元），但会导致12352个QALY损失，价值12亿美元。因此，各州在限制为低收入艾滋病毒/艾滋病感染者增加抗逆转录病毒疗法获取机会的项目时应谨慎行事。
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