Aghlmandi Soheila, Schmidlin Kurt, Huber Carola, Godet Pascal, Kusejko Katharina, Stoeckle Marcel, Cavassini Matthias, Günthard Huldrych F, Bernasconi Enos, Calmy Alexandra, Schmid Patrick, Staehelin Cornelia, Labhardt Niklaus D, Bucher Heiner C
Division of Clinical Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland.
Paediatric Research Center, University of Basel Children's Hospital, Basel, Switzerland.
Open Forum Infect Dis. 2025 Jul 16;12(8):ofaf410. doi: 10.1093/ofid/ofaf410. eCollection 2025 Aug.
In Switzerland detailed individual patient data are lacking on trends in health care costs, major drivers of costs, and the contribution of breakthrough innovations, such as direct-acting agents (DAAs) for the treatment of chronic hepatitis C virus (HCV) infection in people with HIV (PWH).
We linked anonymized data of patients undergoing antiretroviral therapy (ART) or naive patients initiating ART between 2012 and 2017 in the Swiss HIV Cohort Study with claims data of health insurers covering 35% of Swiss residents. Trends in mean annual costs for overall care, ART, and hospitalizations were calculated with an adjustment of costs for censoring. Changes in costs over time in relation to patient characteristics, comorbidities, and treatment of HCV with DAAs were estimated by linear mixed models. Costs were reported in Swiss francs (CHF).
The final linked file contained 1830 individuals from 11 286 participants of the Swiss HIV Cohort Study and 5406 claims records (33.9%). The mean adjusted annual overall cost in 2012 was CHF 24 713 (SD, 14 107) and increased in 2017 by 1.2% to CHF 24 881 (SD, 14 523). Costs for ART contributed by far most to overall costs but decreased over time. Mean costs for hospitalizations increased with annual variation by 7.2% from CHF 8727 (SD, 10 473) in 2012 to CHF 9406 (SD, 9696) in 2017. Mean increases of costs for DAAs for 171 PWH coinfected with HCV (9.4%) were CHF 52 647 (95% CI, 50 862-54 431; < .01).
Increases in mean total costs for PWH in Switzerland from 2012 to 2017 were small. The contribution of DAAs for the treatment of chronic HCV to overall costs was marginal.
在瑞士，缺乏关于医疗保健成本趋势、主要成本驱动因素以及突破性创新（如用于治疗感染人类免疫缺陷病毒（HIV）的慢性丙型肝炎病毒（HCV）感染者的直接作用抗病毒药物（DAA））贡献的详细个体患者数据。
我们将2012年至2017年期间在瑞士HIV队列研究中接受抗逆转录病毒治疗（ART）的患者或开始接受ART的初治患者的匿名数据与覆盖35%瑞士居民的健康保险公司的理赔数据相链接。计算总体护理、ART和住院的年均成本趋势，并对审查成本进行调整。通过线性混合模型估计与患者特征、合并症以及使用DAA治疗HCV相关的成本随时间的变化。成本以瑞士法郎（CHF）报告。
最终的链接文件包含来自瑞士HIV队列研究的11286名参与者中的1830名个体以及5406条理赔记录（33.9%）。2012年调整后的年均总成本为24713瑞士法郎（标准差，14107），2017年增加了1.2%，达到24881瑞士法郎（标准差，14523）。ART成本对总成本的贡献最大，但随时间下降。住院平均成本逐年变化，从2012年的8727瑞士法郎（标准差，10473）增加到2017年的9406瑞士法郎（标准差，9696），增幅为7.2%。171名合并感染HCV的HIV感染者（9.4%）使用DAA的成本平均增加52647瑞士法郎（95%置信区间，50862 - 54431；P <.01）。
2012年至2017年瑞士HIV感染者的平均总成本增幅较小。用于治疗慢性HCV的DAA对总成本的贡献微不足道。
