Jo Youngji, Rosen Sydney, Nichols Brooke E, Jamieson Lise, Lekodeba Nkgomeleng, Horsburgh Robert
Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, Connecticut, USA.
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
J Int AIDS Soc. 2025 Feb;28(2):e26413. doi: 10.1002/jia2.26413.
In the current era of universal antiretroviral treatment (ART), health systems have the dual challenge of a growing number of people living with HIV and on ART who are also receiving chronic, life-long treatment for non-communicable diseases. Current evidence suggests that 6-month multi-month dispensing (6MMD) can maintain at least equivalent clinical outcomes to conventional care and reduce costs, but little is known when integrating 6MMD for multiple conditions. We examined the cost-effectiveness of integrated multi-month drug dispensing for people living with HIV and hypertension.
Using an age- and sex-specific hybrid decision tree and Markov state-transition model, we constructed a 100,000-person simulated population cohort who may develop HIV and hypertension and initiate treatment at clinics in South Africa over a 10-year time horizon. We assessed the incremental costs and effectiveness of 6MMD versus conventional care from a health system perspective under different conditions of care-seeking, eligibility and uptake of 6MMD for clinically stable patients. Model inputs were sourced from previously published literature. 6MMD was defined as reducing the frequency of clinic visits by increasing the number of medications dispensed to stable patients at each visit from 3 to 6 months. For the integrated 6MMD, we assumed that comorbid patients receive both HIV and hypertension drugs at the same facility on the same day.
Our study demonstrates that integrated 6MMD for HIV and hypertension in South Africa can avert between 0.8 and 1 DALYs and increase health systems costs between $24 and $49 per patient per year, compared to the status quo. One-way sensitivity analysis showed that HTN drug cost and prevalence of HIVHTN and HIV were key drivers in the cost per DALYs averted. Overall, integrated 6MMD with a greater proportion of well-controlled patients and lower mortality rates led to greater cost savings or better cost-effectiveness (less than $50 per DALY averted) across a wide range of loss-to-follow-up (LTFU) factor variation.
By better controlling disease among patients already in care, integrated 6MMD can be more beneficial than the status quo treatment by resulting in fewer cases of LTFU and fewer deaths through high-quality care.
在当前普遍开展抗逆转录病毒治疗（ART）的时代，卫生系统面临双重挑战，即感染艾滋病毒且正在接受ART治疗的人数不断增加，这些人同时还在接受慢性、终身的非传染性疾病治疗。目前的证据表明，6个月多剂量配药（6MMD）可维持至少与传统治疗相当的临床效果并降低成本，但对于将6MMD用于多种疾病的整合情况知之甚少。我们研究了针对艾滋病毒感染者和高血压患者的整合式多月份药物配药的成本效益。
我们使用特定年龄和性别的混合决策树及马尔可夫状态转换模型，构建了一个10万人的模拟人群队列，这些人可能会感染艾滋病毒和患高血压，并在南非的诊所开始接受为期10年的治疗。我们从卫生系统的角度，在不同的就医条件、6MMD的资格和临床稳定患者对其的接受情况等条件下，评估了6MMD与传统治疗相比的增量成本和效果。模型输入数据来源于先前发表的文献。6MMD的定义是通过将每次就诊时分发给稳定患者的药物数量从3个月增加到6个月来减少就诊频率。对于整合式6MMD，我们假设合并症患者在同一天在同一机构接受艾滋病毒和高血压药物治疗。
我们的研究表明，与现状相比，南非针对艾滋病毒和高血压的整合式6MMD每年可避免0.8至1个伤残调整生命年（DALY），并使卫生系统成本每名患者每年增加24美元至49美元。单向敏感性分析表明，高血压药物成本以及艾滋病毒合并高血压和艾滋病毒的患病率是每避免一个DALY成本的关键驱动因素。总体而言，在广泛的失访（LTFU）因素变化范围内，整合式6MMD中病情得到更好控制的患者比例更高且死亡率更低，会带来更大的成本节约或更好的成本效益（每避免一个DALY成本低于50美元）。
通过更好地控制已接受治疗患者的疾病，整合式6MMD可能比现状治疗更有益，因为高质量护理可减少失访病例和死亡人数。
