Center for Interdisciplinary Medicine (CIM) Infectious Diseases, Muenster, Germany.
Department of Gastroenterology and Hepatology, Muenster University Hospital, Muenster, Germany.
PLoS One. 2019 Nov 6;14(11):e0224279. doi: 10.1371/journal.pone.0224279. eCollection 2019.
People living with human immunodeficiency virus (PLHIV) are at high risk of developing non-HIV related comorbidities, particularly at older ages. In a retrospective claims database analysis, we compared PLHIV to a matched, non-HIV cohort to assess the prevalence of comorbidities and healthcare costs in PLHIV and the general non-HIV population in Germany. In total, 2,132 adult patients with HIV were identified in the InGef research database with HIV ICD-10 diagnosis within each year from 2011 to 2014. Of these, 1,969 could be matched to a control cohort of 3,938 individuals (1:2 ratio). Matching criteria included age, gender and socio-economic variables. The prevalence of acute renal disease (0.5% vs. 0.2%, p = 0.045), bone fractures due to osteoporosis (6.4% vs. 2.1%, p<0.001), chronic renal disease (4.3% vs. 2.4%, p<0.001), cardiovascular disease (12.8% vs. 10.4%, p = 0.006), Hepatitis B (5.9% vs. 0.3%, p<0.001) and Hepatitis C infection (8.8% vs. 0.3%, p<0.001) was significantly higher in PLHIV compared to the matched non-HIV cohort. Mean costs excluding costs for antiretroviral therapy (ART) were significantly higher in the HIV cohort (8,049€ vs. 3,658€, p<0.05). On average, PLHIV incurred excess costs of 16,441€ for ART, 2,747€ for pharmaceuticals excluding ART (p<0.05), 1,441€ for outpatient care (p<0.05) and 321€ for inpatient care (p<0.05). Devices and remedies' costs were significantly higher in the control cohort with excess costs of 113€ (p<0.05). Considering mean total costs, excluding ART, excess costs for PLHIV amounted to 8,049€ (p<0.05). This analysis demonstrated an increased comorbidity and economic burden of PLHIV compared to matched controls. Our findings suggest that HIV remains an area of high unmet medical need. To improve patient outcomes, adequate HIV management including regular monitoring, screening for comorbidities and optimal ART selection throughout the life course of PLHIV are of key importance.
患有人类免疫缺陷病毒 (PLHIV) 的人患非 HIV 相关合并症的风险很高，尤其是在年龄较大时。在一项回顾性理赔数据库分析中，我们将 PLHIV 与匹配的非 HIV 队列进行了比较，以评估德国 PLHIV 和普通非 HIV 人群中合并症的患病率和医疗保健费用。在 InGef 研究数据库中，共确定了 2132 名患有 HIV 的成年患者，这些患者在 2011 年至 2014 年期间每年都有 HIV ICD-10 诊断。其中，1969 名患者可以与 3938 名个体的对照组相匹配（1:2 比例）。匹配标准包括年龄、性别和社会经济变量。急性肾脏疾病的患病率（0.5% vs. 0.2%，p = 0.045）、骨质疏松症引起的骨折（6.4% vs. 2.1%，p<0.001）、慢性肾脏疾病（4.3% vs. 2.4%，p<0.001）、心血管疾病（12.8% vs. 10.4%，p = 0.006）、乙型肝炎（5.9% vs. 0.3%，p<0.001）和丙型肝炎感染（8.8% vs. 0.3%，p<0.001）在 PLHIV 中明显高于匹配的非 HIV 队列。排除抗逆转录病毒治疗 (ART) 费用后，HIV 队列的平均费用明显较高（8049 欧元 vs. 3658 欧元，p<0.05）。平均而言，PLHIV 因 ART 产生的超额费用为 16441 欧元，ART 以外的药物费用为 2747 欧元（p<0.05），门诊护理费用为 1441 欧元（p<0.05），住院护理费用为 321 欧元（p<0.05）。器械和治疗费用在对照组中明显较高，超额费用为 113 欧元（p<0.05）。考虑到平均总费用，不包括 ART，PLHIV 的超额费用为 8049 欧元（p<0.05）。该分析表明，与匹配的对照组相比，PLHIV 的合并症和经济负担增加。我们的研究结果表明，HIV 仍然是一个高度未满足医疗需求的领域。为了改善患者的预后，包括定期监测、筛查合并症和在 PLHIV 的整个生命周期中选择最佳的 ART 在内的适当 HIV 管理至关重要。
