Medical Resource Utilization and Cost of HIV-Related Care in the Highly Active Antiretroviral Therapy Era at a University Clinic in Sweden
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Introduction: Little is known regarding healthcare costs for HIV/AIDS patients in the era of highly active antiretroviral therapy (HAART) and subgroups of patients according to the severity and progression of HIV infection in Sweden. The objective of this study is therefore to describe the direct medical resource use and cost of healthcare for HIV patients at a university clinic in Sweden.
Methods: A patient registry database for HIV treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, between 2000 and 2005 provided information on patient characteristics, antiretroviral drugs and dosages, tests and diagnostic procedures, outpatient visits and inpatient stays. The review used publicly available unit costs with a county council perspective, expressed in 2006 Euros.
Results: Two hundred and eighty-five patients with a mean age of 38 years in 2000 (64% men) were followed for 1368 patient-years. They had a mean (median) of 6.3 (0) inpatient days, 4.1 (3.7) physician visits, 4.2 (3.8) nurse visits, 2.6 (0.7) counsellor visits and 11.5 (7.7) tests and diagnostic procedures per patient-year. Only 12 deaths were recorded during the study period, and the proportion of treated patients with successful treatment (HIV-RNA <50 copies/mL) increased from 74% to 92% during the period. The mean cost per patient-month amounted to h1069. The main cost driver was HIV drugs (51%), followed by inpatient stays (including hospitalizations for opportunistic infections; 22%), outpatient physician, nurse or therapist visits (19%) and diagnostics and tests (7%). All non-drug costs increased with a decreasing CD4 cell count.
Conclusions: Overall, approximately half of the direct costs of HIV treatment were not related to antiretroviral treatment. The non-antiretroviral costs were inversely correlated with HIV-induced immune deficiency.
KeywordsDrug Cost Inpatient Stay Inpatient Cost Fusion Inhibitor Main Cost Driver
The authors would like to thank Lissie Johansson and Elisabeth Pamryd for assistance with data collection. The authors also acknowledge Caroline Waterhouse (editorial assistant, Gardiner-Caldwell Communications, Macclesfield, UK) for her editorial support. This study was supported by Tibotec, a division of Janssen-Cilag AB. This support has facilitated the data collection, management, analysis and manuscript preparation. The analysis plan was developed before the initiation of the study.
OG and CH are both employees at IHE, which has received research grants from Janssen-Cilag AB, within the past 2 years. MG has taken part in scientific advisory boards and received honoraria for lecturers and seminars sponsored by all pharmaceutical companies involved in the HIV area. He has also received scientific grants from Bristol Myers Squibb, GlaxoSmithKline, Abbott and Tibotec. SL and ML are employees of Janssen-Cilag and own stocks in Johnson & Johnson.
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