School of Public Health, Boston University, Boston, Massachusetts, USA.
Health Economics and Epidemiology Research Office, Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2024 Feb;27(2):e26208. doi: 10.1002/jia2.26208.
The LINC-II randomized controlled trial in St. Petersburg, Russia for HIV-positive adults who inject drugs found that a multi-component intervention including initiation of antiretroviral therapy (ART) during admission to an addiction hospital, strengths-based case management and naltrexone significantly increased 12-month HIV viral suppression and ART retention. We conducted a comparative cost analysis to determine if the 12-month cost of the intervention is affordable within the current Russian health system.
We used LINC-II trial records and questionnaire responses to calculate the resources utilized by each participant in the study, including inpatient days, medications, laboratory tests, outpatient consultations, case manager interactions and opioid medication treatment. Quantities of resources utilized were multiplied by unit costs for each resource estimated from the service fee or price lists used by the study facilities for each specific service delivered. We report the average cost/study primary (viral suppression at 12 months) or secondary (retention in care at 12 months) outcome/participant in 2021 USD and compare costs between study arms.
The trial enrolled 225 participants (111 intervention, 114 control) between September 2018 and December 2020. Viral suppression, non-suppression and missing suppression results were 28% and 14%, 49% and 37%, and 31% and 41% for the control and intervention arms, respectively. Retention results were 35% and 51% for the control and intervention arms, respectively. The average cost per study participant was $2714 in the control arm and $4342 in the intervention arm. The average cost per participant virally suppressed at 12 months was $3662 (control) and $6355 (intervention). The average cost per participant retained at 12 months was $4050 (control) and $5448 (intervention). For those retained, the cost difference between the arms was comprised of opioid treatment (35%), case management (31%), outpatient visits (18%) and additional days of ART (12%).
The LINC-II intervention increased the cost of care for HIV-positive people who inject drugs in Russia significantly, but some components of the intervention, particularly earlier initiation of ART and case management, may be justifiable due to their success in reaching a challenging subgroup of the population in need.
NCT03290391.
俄罗斯圣彼得堡的 LINC-II 随机对照试验纳入了 HIV 阳性的吸毒者，结果表明，包括在成瘾医院住院期间开始抗逆转录病毒治疗（ART）、以优势为基础的个案管理和纳曲酮在内的多组分干预措施显著提高了 12 个月时的 HIV 病毒抑制和 ART 保留率。我们进行了成本比较分析，以确定该干预措施的 12 个月成本在当前俄罗斯卫生系统是否可负担。
我们使用 LINC-II 试验记录和问卷调查的回复来计算研究中每位参与者使用的资源，包括住院天数、药物、实验室检查、门诊咨询、个案管理人员的互动和阿片类药物治疗。使用研究设施提供的每项服务的服务收费或价格表来估计每种资源的单位成本，然后将使用的资源数量乘以单位成本。我们报告了以 2021 年美元计价的每例（12 个月时病毒抑制）或次要（12 个月时治疗保留）结局/参与者的平均成本，并比较了研究组之间的成本。
该试验于 2018 年 9 月至 2020 年 12 月期间纳入了 225 名参与者（111 名干预组，114 名对照组）。对照组和干预组的病毒抑制、未抑制和缺失抑制结果分别为 28%和 14%、49%和 37%，以及 31%和 41%。对照组和干预组的保留结果分别为 35%和 51%。对照组和干预组的每名参与者的平均试验成本分别为 2714 美元和 4342 美元。12 个月时病毒抑制的每名参与者的平均成本分别为 3662 美元（对照组）和 6355 美元（干预组）。12 个月时保留的每名参与者的平均成本分别为 4050 美元（对照组）和 5448 美元（干预组）。对于保留者，臂间的成本差异包括阿片类药物治疗（35%）、个案管理（31%）、门诊就诊（18%）和 ART 附加天数（12%）。
LINC-II 干预措施显著增加了俄罗斯 HIV 阳性吸毒者的治疗成本，但该干预措施的某些组成部分，特别是早期开始 ART 和个案管理，由于它们成功地为有需要的人群中的一个具有挑战性的亚组提供了服务，因此可能是合理的。
NCT03290391。
