Chen Cindy Y, Donga Prina, Campbell Alicia K, Taiwo Babafemi
Janssen Scientific Affairs, LLC, Titusville, New Jersey.
Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Health Econ Outcomes Res. 2023 Jan 19;10(1):10-19. doi: 10.36469/001c.56928. eCollection 2023.
With advances in antiretroviral therapy (ART), people with HIV infection are living longer. Pre-exposure prophylaxis (PrEP) to reduce HIV infection risk continues to be underutilized in high-risk individuals. Recent data on economic burden for patients with newly diagnosed HIV-1 or initiated with PrEP are limited. To assess characteristics, healthcare resource utilization (HRU), and costs among adults and adolescents either with newly diagnosed HIV-1 or initiated with PrEP. This retrospective observational study utilized data from the IBM MarketScan® Commercial Claims and Encounters database. Adults with newly diagnosed HIV-1 or those initiated with PrEP were included (index date was the first HIV diagnosis or PrEP prescription, respectively, between January 1, 2016, and April 30, 2021). Corresponding cohorts of adolescents were considered exploratory. Descriptive analyses were conducted to assess baseline demographics and clinical characteristics, and all-cause and HIV-related HRU and costs per patient per month (PPPM) during follow-up. Data from 18 154 adults and 220 adolescents with newly diagnosed HIV and 34 123 adults and 175 adolescents initiated with PrEP were included. Approximately 70% of adolescents and 9% of adults receiving PrEP were female. Baseline depression/anxiety was present in 16.1% and 24.6% of adults and 14.5% and 45.1% of adolescents in the HIV and PrEP cohorts, respectively. Substance abuse in the HIV and PrEP cohorts, respectively, was reported in 10.1% and 7.0% of adults, and 2.7% and 17.7% of adolescents. During follow-up, among adults with newly diagnosed HIV, mean (SD) total all-cause and HIV-related PPPM costs were $2657 ($5954) and $1497 ($4463), respectively; pharmacy costs represented 47% of all-cause costs and 67% of HIV-related costs, but only 37% of patients had an HIV-related prescription. All-cause costs PPPM for adults with PrEP were $1761 ($1938), with pharmacy costs accounting for 71%. Despite advances in ART, patients with newly diagnosed HIV and at-risk patients receiving PrEP continue to incur HRU costs. The chronic nature of HIV warrants further exploration of factors contributing to disease burden and opportunities to improve prevention strategies.
随着抗逆转录病毒疗法（ART）的进步，感染艾滋病毒的人寿命更长。暴露前预防（PrEP）以降低艾滋病毒感染风险在高危人群中仍未得到充分利用。关于新诊断为HIV-1或开始接受PrEP治疗的患者经济负担的最新数据有限。为了评估新诊断为HIV-1或开始接受PrEP治疗的成人和青少年的特征、医疗资源利用（HRU）和成本。这项回顾性观察研究利用了IBM MarketScan®商业索赔和病历数据库中的数据。纳入新诊断为HIV-1的成人或开始接受PrEP治疗的成人（索引日期分别为2016年1月1日至2021年4月30日期间的首次HIV诊断或PrEP处方）。相应的青少年队列被视为探索性队列。进行描述性分析以评估基线人口统计学和临床特征，以及随访期间每位患者每月的全因和与HIV相关的HRU及成本（PPPM）。纳入了18154名新诊断为HIV的成人和220名青少年以及34123名开始接受PrEP治疗的成人和175名青少年的数据。接受PrEP治疗的青少年中约70%为女性，成人中这一比例为9%。HIV队列和PrEP队列中，成人基线抑郁/焦虑的比例分别为16.1%和24.6%，青少年分别为14.5%和45.1%。HIV队列和PrEP队列中，分别有10.1%的成人和7.0%的青少年以及2.7%的青少年和17.7%的青少年报告有药物滥用情况。在随访期间，新诊断为HIV的成人中，平均（标准差）全因和与HIV相关的PPPM成本分别为2657美元（5954美元）和1497美元（4463美元）；药房成本占全因成本的47%，占与HIV相关成本的67%，但只有37%的患者有与HIV相关的处方。接受PrEP治疗的成人全因成本PPPM为1761美元（1938美元），药房成本占71%。尽管ART取得了进展，但新诊断为HIV的患者和接受PrEP治疗的高危患者仍需承担HRU成本。HIV的慢性性质值得进一步探索导致疾病负担的因素以及改善预防策略的机会。
