Service de Maladies Infectieuses et Tropicales, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.
INSERM UMS 011, Villejuif, France.
PLoS One. 2020 Dec 17;15(12):e0243529. doi: 10.1371/journal.pone.0243529. eCollection 2020.
As people living with HIV (PLHIV) age, the burden of non-HIV related comorbidities increases resulting in additional healthcare costs. The present study aimed to describe the profile, the prevalence and the incremental costs of non-HIV related comorbidities in PLHIV compared to non-HIV matched controls (1:2 ratio) in France.
The French permanent sample of health beneficiaries (Echantillon généraliste de bénéficiaires [EGB]), a claims database representative of the national population, was used to assess comorbidities in PLHIV which were identified by the ICD-10 diagnosis codes of hospitalization, full healthcare coverage, and drug reimbursements between 2011 and 2014. The control group was matched by year of birth, gender, region of residence, and economic status. Total costs of outpatient care and hospitalizations were analysed from a societal perspective. A general linear model was used to assess the incremental cost per patient in PLHIV.
A total of 1,091 PLHIV and 2,181 matched controls were identified with a mean ± standard deviation age of 46.7 ± 11.5 years. The prevalence of alcohol abuse (5.8% vs 3.1%; p<0.001), chronic renal disease (1.2% vs 0.3%; p = 0.003), cardiovascular disease (7.4% vs 5.1%; p = 0.009), dyslipidaemia (22% vs 15.9%; p<0.001), hepatitis B (3.8% vs 0.1%; p<0.001) and hepatitis C (12.5% vs 0.6%; p<0.001) was significantly higher in PLHIV compared with non-HIV controls. Other comorbidities such as anaemia, malnutrition, psychiatric diseases, and neoplasms were also more prevalent in PLHIV. Hospitalizations were significantly increased in PLHIV compared to controls (33.2% vs 16%; p<0.001). Mean total cost was 6 times higher for PLHIV compared to controls and 4 times higher after excluding antiretroviral drugs (9,952€ vs. 2,593€; p<0.001). Higher costs per person in PLHIV were significantly associated to aging (42€ per patient/year), chronic cardiovascular disease (3,003€), hepatitis C (6,705€), metastatic carcinoma (6,880€) and moderate or severe liver disease (6,299€).
Our results demonstrated an increase in non-HIV related comorbidities among PLHIV compared to matched controls. This study contributes to raise awareness on the burden of chronic comorbidities.
随着艾滋病毒感染者（PLHIV）年龄的增长，非艾滋病毒相关合并症的负担增加，导致额外的医疗保健费用。本研究旨在描述法国 PLHIV 与非 HIV 匹配对照（1:2 比例）相比，非 HIV 相关合并症的特征、患病率和增量成本。
本研究使用法国永久受益人群样本（Echantillon généraliste de bénéficiaires [EGB]），这是一个代表全国人口的索赔数据库，通过住院、全面医疗覆盖和药物报销的 ICD-10 诊断代码来确定 PLHIV 的合并症。对照组通过出生年份、性别、居住地区和经济状况进行匹配。从社会角度分析门诊护理和住院治疗的总费用。使用一般线性模型评估 PLHIV 每位患者的增量成本。
共确定了 1091 名 PLHIV 和 2181 名匹配对照，平均年龄为 46.7±11.5 岁。PLHIV 组酒精滥用（5.8%比 3.1%；p<0.001）、慢性肾脏疾病（1.2%比 0.3%；p=0.003）、心血管疾病（7.4%比 5.1%；p=0.009）、血脂异常（22%比 15.9%；p<0.001）、乙型肝炎（3.8%比 0.1%；p<0.001）和丙型肝炎（12.5%比 0.6%；p<0.001）的患病率明显高于非 HIV 对照组。PLHIV 还存在其他合并症，如贫血、营养不良、精神疾病和肿瘤。与对照组相比，PLHIV 的住院治疗显著增加（33.2%比 16%；p<0.001）。PLHIV 的总费用平均是对照组的 6 倍，排除抗逆转录病毒药物后是对照组的 4 倍（9952 欧元比 2593 欧元；p<0.001）。PLHIV 中每增加一个人，成本显著增加，与年龄增长（42 欧元/患者/年）、慢性心血管疾病（3003 欧元）、丙型肝炎（6705 欧元）、转移性癌（6880 欧元）和中重度肝脏疾病（6299 欧元）相关。
我们的研究结果表明，与匹配对照组相比，PLHIV 的非艾滋病毒相关合并症有所增加。这项研究有助于提高对慢性合并症负担的认识。
