抗逆转录病毒治疗依从性与艾滋病定义性疾病相关的经济负担降低。

Reduced economic burden of AIDS-defining illnesses associated with adherence to antiretroviral therapy.

机构信息

Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

出版信息

Int J Infect Dis. 2020 Feb;91:44-49. doi: 10.1016/j.ijid.2019.11.010. Epub 2019 Nov 15.

DOI:10.1016/j.ijid.2019.11.010

PMID:31740407

Abstract

OBJECTIVES

We assessed the economic burden of AIDS-defining illnesses (ADIs), which was further stratified by adherence to antiretroviral therapy (ART).

METHODS AND MATERIALS

A nationwide longitudinal cohort of 18,234 incident cases with HIV followed for 11years was utilized. Adherence to ART was measured by medication possession ratio (MPR). Generalized estimating equations modeling was used to estimate the cost impact of ADIs.

RESULTS

Having opportunistic infections increased the annual cost by 9% (varicella-zoster virus infection) to 98% (cytomegalovirus disease), while the annual costs increased by 26% (Kaposi's sarcoma) to 95% (non-Hodgkin's lymphoma) in the year when AIDS-related cancer occurred. ADIs occurred more frequently in the years with low adherence for ART compared to the high-adherence years (e.g., 0.1≤MPR<0.8 vs. MPR≥0.8, event rate of cytomegalovirus disease 4.03% vs. 0.51%). The annual baseline costs in the years with MPR<0.1, 0.1≤MPR<0.8, and MPR≥0.8 were $250, $4,752, and $8,990 (in 2018 USD), respectively. The economic impact of ADIs in the years with low adherence (MPR<0.1) was larger than that in the high-adherence years (MPR≥0.8) (e.g., MPR<0.1 vs. MPR≥0.8, annual cost increased by 244% vs. 9% when candidiasis occurred).

CONCLUSIONS

Adherence to ART may increase the baseline medical costs but mitigate the incidence and economic burden of ADIs.

摘要

目的

我们评估了艾滋病定义性疾病（ADIs）的经济负担，并进一步根据抗逆转录病毒治疗（ART）的依从性进行分层。

方法和材料

利用了一项全国性的纵向队列研究，该研究纳入了 18234 例 HIV 新发病例，随访时间为 11 年。通过药物持有率（MPR）来衡量 ART 的依从性。使用广义估计方程模型来估计 ADIs 的成本影响。

结果

发生机会性感染会使每年的成本增加 9%（水痘带状疱疹病毒感染）至 98%（巨细胞病毒病），而发生艾滋病相关癌症的那一年，每年的成本增加 26%（卡波西肉瘤）至 95%（非霍奇金淋巴瘤）。与高依从性年份相比，ART 低依从性年份更易发生 ADIs（例如，0.1≤MPR<0.8 与 MPR≥0.8，巨细胞病毒病的发生率分别为 4.03%和 0.51%）。MPR<0.1、0.1≤MPR<0.8 和 MPR≥0.8 年份的年度基线成本分别为 250 美元、4752 美元和 8990 美元（按 2018 年美元计算）。低依从性（MPR<0.1）年份 ADIs 的经济影响大于高依从性年份（MPR≥0.8）（例如，MPR<0.1 与 MPR≥0.8，当念珠菌病发生时，年度成本分别增加了 244%和 9%）。