The Impact of Disease Stage on Direct Medical Costs of HIV Management
- 147 Downloads
The global prevalence of HIV infection continues to grow, as a result of increasing incidence in some countries and improved survival where highly active antiretroviral therapy (HAART) is available. Growing healthcare expenditure and shifts in the types of medical resources used have created a greater need for accurate information on the costs of treatment. The objectives of this review were to compare published estimates of direct medical costs for treating HIV and to determine the impact of disease stage on such costs, based on CD4 cell count and plasma viral load.
A literature review was conducted to identify studies meeting prespecified criteria for information content, including an original estimate of the direct medical costs of treating an HIV-infected individual, stratified based on markers of disease progression. Three unpublished cost-of-care studies were also included, which were applied in the economic analyses published in this supplement. A two-step procedure was used to convert costs into a common price year (2004) using country-specific health expenditure inflators and, to account for differences in currency, using health-specific purchasing power parities to express all cost estimates in US dollars.
In all nine studies meeting the eligibility criteria, infected individuals were followed longitudinally and a ‘bottom-up’ approach was used to estimate costs. The same patterns were observed in all studies: the lowest CD4 categories had the highest cost; there was a sharp decrease in costs as CD4 cell counts rose towards 100 cells/mm3; and there was a more gradual decline in costs as CD4 cell counts rose above 100 cells/mm3. In the single study reporting cost according to viral load, it was shown that higher plasma viral load level (>100 000 HIV-RNA copies/mL) was associated with higher costs of care. The results demonstrate that the cost of treating HIV disease increases with disease progression, particularly at CD4 cell counts below 100 cells/mm3. The suggestion that costs increase as the plasma viral load rises needs independent verification. This review of the literature further suggests that publicly available information on the cost of HAART by disease stage is inadequate. To address the information gap, multiple stakeholders (governments, pharmaceutical industry, private insurers and non-governmental organizations) have begun to establish and support an independent, high quality and standardized multicountry data collection for evaluating the cost of HIV management. An accurate, representative and relevant cost-estimate data resource would provide a valuable asset to healthcare planners that may lead to improved policy and decision-making in managing the HIV epidemic.
KeywordsViral Load Direct Medical Cost Plasma Viral Load Improve Policy Viral Load Testing
The authors gratefully acknowledge Brian Harrigan, Patrick Hoggard and Erik Smets. This project was financially supported by Johnson & Johnson Pharmaceutical Services with an unrestricted research grant to Oxford Outcomes, a consultancy specializing in contract research for a wide range of clients in the life sciences industry, including both public sector organizations as well as pharmaceutical and other private companies. AL is a shareholder in Oxford Outcomes Ltd. KJ is an employee of Oxford Outcomes Ltd. LA has received consultancy fees from Johnson & Johnson in the field of HIV/AIDS. JM has received grants from, served as an ad-hoc advisor to, or spoke at various events sponsored by Abbott, Argos Therapeutics, Bioject Inc., Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Hoffman-La Roche, Janssen-Ortho, Merck Frosst, Panacos, Pfizer, Serono Inc., TheraTechnologies, Tibotec (J&J) and Trimeris. AT declares no conflict of interest.
- 8.European AIDS Clinical Society. European Treatment Guidelines. 2005 [online]. Available at: (http://www.europeanaidsclinicalsociety.org/Guidelines/index.htm) [Accessed 2010 Nov 28]Google Scholar
- 11.Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of Antiretroviral agents in HIV-1-infected individuals. Department of Health and Human Services; 2009: 1–161 [online]. Available at: (http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf) [Accessed 2010 Nov 28]Google Scholar
- 13.Yazdanpanah Y, Goldie SJ, Losina E, et al. Lifetime cost of HIV care in France during the era of highly active antiretroviral therapy. Antiviral Ther 2002; 7: 257–66Google Scholar
- 24.Caekelbergh K, Moeremans K, Annemans L, et al. Cost of care for HIV/AIDS in Belgium according to disease stage [Abstract P19.5/01]. 11th European AIDS Conference. 2007Google Scholar
- 25.Ghatnekar O, Gisslen M, Hjortsberg C, et al. Medical resource use and cost of HIV-related care in the HAART era at a university clinic in Sweden [abstract P19.10/01]. 11th European AIDS Conference. 2007Google Scholar
- 28.Hoffmann JP. Generalized linearmodels: an applied approach. Upper Saddle River, NJ, USA; Pearson Education, 2004Google Scholar
- 30.Garattini L, Tediosi F, Di Cintio E, et al. Resource utilization and hospital cost of HIV/AIDS care in Italy in the era of highly active antiretroviral therapy. AIDS CarePsycholog Socio-Med Aspects AIDS/HIV 2001; 13: 733–41Google Scholar
- 33.Gebo K, Fleishman J, Conviser R, et al. Contemporary costs of HIV health care in the HAART era [abstract 537]. 13th Conference on Retroviruses and Opportunistic Infections. Denver, CO. 2006Google Scholar
- 34.Drummond M, O’Brien B, Stoddart G, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford Medical Publications, Oxford, UK, 1997Google Scholar
- 44.Richman DD. Human immunodeficiency virus. International Medical Press, London, UK, 2003Google Scholar
- 52.Joint United Nations Programme on HIV/AIDS (UNAIDS). 2010 Available at: (http://www.unaids.org/en/PolicyAndPractice/ResourcesAndFunding/default.asp) [Accessed 2010 Nov 28]