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Ökonomische Aspekte der ambulanten und stationären Behandlung HIV-Infizierter

  • Schwerpunkt: HIV
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"Nach Golde drängt, am Golde hängt doch alles. Ach wir Armen! [28]"

Zusammenfassung

Das seit Mitte der 1990er Jahre eingeführte Konzept der hochwirksamen antiretroviralen Kombinationstherapie (HAART) erfordert deren dauerhafte und regelmäßige Verabreichung. Die damit verbundenen direkten Kosten für die vergleichsweise teuren antiretroviralen Substanzen fallen somit dauerhaft an und verursachen für die HIV-Infektion hierzulande derzeit etwa zwei Drittel aller direkten Behandlungskosten von etwa 20.000–30.000 € pro Fall und Jahr. Die Therapie ist dennoch kosteneffektiv, weil die anhaltende Senkung der Morbidität und Mortalität hohe Kosten insbesondere in der stationären Behandlung vermeidet. In Kosten-Nutzwert-Analysen lagen der Ressourcenverbrauch für den Gewinn eines "lebensqualität-adjustierten Lebensjahres" (QALY) durch HAART bei unter 30.000 € und damit in einem in der westlichen Welt allgemein akzeptierten Bereich. Seit Einführung von HAART haben die direkten Kosten der HIV-Infektion weiter abgenommen und durch künftige Änderungen der bestehenden Therapiekonzepte sind möglicherweise weitere Einsparungen zu erwarten.

Abstract

Highly active antiretroviral therapy (HAART) was introduced in the midst of the 1990s. The sustained decline of morbidity and mortality by HAART has been proven to be cost effective despite high expenditures for regular administration of cost intensive antiretroviral drugs. Yearly direct treatment costs are estimated as high as € 20,000 to € 30,000 per case in Germany. Approximately two third of all direct costs are caused by the use of antiretrovirals. Despite rising use of HAART and increasing drug prices, general costs for treatment decreased in the last years. This is explained by declining costs for hospitalisation and by increasing use of less expensive drug combinations. In addition deferment of initiation of HAART to slightly more advanced stages of immunodeficiency is recommended in recent treatment guidelines and leads to further reduction of direct costs. Modified treatment concepts with presumed cost saving effects, like periods of antiretroviral treatment interruption, are currently under investigation.

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  1. Abteilung klinische Immunologie, Medizinische Hochschule Hannover

    M. Stoll & R. E. Schmidt

  2. Abteilung Klinische Immunologie, Medizinische Hochschule, 30623, Hannover

    M. Stoll

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Stoll, M., Schmidt, R.E. Ökonomische Aspekte der ambulanten und stationären Behandlung HIV-Infizierter. Internist 44, 678–693 (2003). https://doi.org/10.1007/s00108-003-0922-8

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