The Cost of Managing HIV Infection in Highly Treatment-Experienced, HIV-Infected Adults in France
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Background: Highly active antiretroviral therapy (HAART) has greatly enhanced HIV management, lowering the risk of clinical disease progression and death by substantially improving HIV-induced immune deficiency. Lower CD4 cell counts have consistently been associated with higher direct costs of HIV patient care. The aim of this study was to analyze HIV costs of care in France at different levels of HIV-induced immune deficiency (as measured by the CD4 cell count) using recent data from treatmentexperienced patients.
Methods: This analysis used data from the French Hospital Database in HIV, containing data on approximately 50% of the French HIV population. Patients were included in the analysis if they had visited a participating centre from 2003 to 2005, had CD4 cell counts determined at least twice during the study period, and had been prescribed at least two nucleoside reverse transcriptase inhibitors, one non-nucleoside reverse transcriptase inhibitor and two protease inhibitors since their first consultation. Resources consumed were counted and aggregated according to the CD4 cell count level. Standard costs were applied.
Results: Periods with the lowest CD4 cell counts were associated with increased prescription rates of antiviral agents (other than anti-HIV agents), antiparasitic drugs and antimycobacterial agents. Antiretroviral treatments accounted for 80% of all medications prescribed during the study period. Hospitalization rates decreased with increasing CD4 cell counts, with 0.72 hospitalizations per patient-year for those with CD4 cell counts of 50 cells/mm3 or less compared with 0.05 per patient-year for patients with CD4 cell counts greater than 500 cells/mm3. There was a clear trend towards lower mean healthcare costs per patient-year with decreasing immune deficiency; from h34 286 to h12 361.
Conclusions: Our study showed an association between the degree of HIVinduced immune deficiency (measured by CD4 cell count) and the costs of managing HIV infection among highly pre-treated, HIV-infected individuals in France in the HAART era.
KeywordsClinical Disease Progression High Direct Cost PMSI Database French Hospital Database Hospitalization Unit Cost
The authors would like to thank Johann Fichou from Inserm for his contributions. They also acknowledge Emily de Looze (medical writer, Gardiner-Caldwell Communications, Macclesfield, UK), for her editorial support. Finally, the authors wish to thank the investigators at the participating FHDH centres and the patients included in this analysis. This project was financially supported by Janssen-Cilag SAS, France.
XC and AL have received study funding from Jansen Cilag. PG has declared that this project was financially supported by Jansen Cilag SAS, France.
- 3.Yéni P. Rapport du Groupe d’Experts 2010 sur la prise en charge médicale des patients infectées par le VIH, (version préliminaire) Recommandations du groupe d’expert. 2010. Available from URL: (http://www.sante-jeunesse-sports.gouv.fr/rapport-2010-sur-la-prise-en-charge-medicale-despersonnes-infectees-par-le-vih-sous-la-direction-du-pr-patrick-yeni.html) [Accessed 2010 Aug 25]Google Scholar
- 4.European AIDS Clinical Society (EACS). 2009 Guidelines for the Clinical Management and Treatment of HIV-infected adults in Europe; Version 5. November 2009 [online]. Available from URL: (http://www.europeanaidsclinicalsociety.org/guidelinespdf/EACS-EuroGuidelines2009FullVersion.pdf) [Accessed 2010 Aug 25]Google Scholar
- 8.Holkmann Olsen C, Gatell J, Ledergerber B, et al. Risk of AIDS and death at given HIV-RNA and CD4 cell counts, in relation to specific antiretroviral drugs in the regimen. AIDS 2005; 19: 319–30Google Scholar
- 11.Gebo K, Fleishman J, Conviser R, et al. Contemporary costs of HIV healthcare in the HAART era [abstract 537]. 13th Conference on Retroviruses and Opportunistic Infections; 2006 Feb 5–8; Denver, USAGoogle Scholar
- 14.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; 2007 Oct 2427; Madrid, SpainGoogle Scholar
- 15.Caeckelbergh 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; 2007 Oct 2427; Madrid, SpainGoogle Scholar
- 17.Hicks C, Cahn P, Cooper DA, et al. Durable efficacy of tipranavirritonavir in combination with an optimised background regimen of antiretroviral drugs for treatmentexperienced HIV-1-infected patients at 48 weeks in the Randomized Evaluation of Strategic Intervention in multidrug resistant patients with Tipranavir (RESIST) studies: an analysis of combined data from two randomised openlabel trials. Lancet 2006; 368: 466–75PubMedCrossRefGoogle Scholar
- 18.Food and Drug Administration (FDA): Press Release: FDA approves darunavir; 2006 Jun 23 [online]. Available from URL: (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108676.htm) [Accessed 2010 Aug 25]Google Scholar
- 19.European Commission Community register of medicinal products for human use. PREZISTA; [online]. Available from URL: (http://ec.europa.eu/enterprise/sectors/pharmaceuticals/documents/community-register/html/h380.htm) [Accessed 2010 Aug 25]
- 21.Food and Drug Administration (FDA) Press Release. FDA approves novel antiretroviral drug; 2007 Aug 6 [online]. Available from URL: (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108960.htm)Google Scholar
- 22.Food and Drug Administration (FDA) Press Release. FDA approves new antiretroviral drug; 2007 Oct 16 [online]. Available from URL: (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm109008.htm) [Accessed 2010 Aug 25]Google Scholar
- 23.Committee for Medicinal Products for Human Use (CHMP); 2007 [online]. Available from URL: (http://www.emea.europa.eu/htms/general/contacts/CHMP/CHMP.html) [Accessed 2010 Aug 25]
- 26.GERS: Groupement pour l’Élaboration et la Réalisation de Statistiques. Nos missions; [online]. Available from URL: (http://www.gie-gers.fr/groupement/qui_sommes_nous.php3) [Accessed 2010 Aug 25]
- 27.Banque Claude Bernard Data base Groupe CEGEDIM, Boulogne Billancourt France; [online]. Available from URL: (http://www.resip.fr) [Accessed 2010 Aug 25]
- 28.Base de données Hospitalière Française sur l’infection à VIH — ANRS CO4 FHDH. Inserm transfert SA, Paris, France, 2007Google Scholar
- 29.ATIH: Agence Technique de l’information sur l’Hospitalisation. PSMI database; [online]. Available from URL: (http://www.atih.sante.fr/) [Accessed 2010 Aug 25]
- 30.World Health Organization. International Classification of Diseases (ICD); [online]. Available from URL: (http://www.who.int/classifications/icd/en/) [Accessed 2010 Aug 25]
- 31.Circulaire DHOS/F3/F1 no 2005-103 du 23 février 2005 relative àla campagne tarifaire 2005 pour les activités de médecine, chirurgie, obstétrique et odontologie exercé es dans les établissements de santéprivés mentionnés aux d) et e) de l’article L. 162-22-6 du code de la sécuritésociale; [online]. Available from URL: (http://www.sante.gouv.fr/adm/dagpb/bo/2005/05-04/somchrono.htm) [Accessed 2010 Aug 25]
- 32.Vallier N, Weill A, Salanave B, et al. Coût des trente affections de longue duré e pour les béné ficiaires du ré gime gé né ral de l’assurance maladie en 2004. Prat Organ Soins 2006; 37: 267–83Google Scholar
- 33.Detournay B, Voinet C, Bez J, et al. Consommation médicale des patients infectés par le VIH suivis à l’Hôpital Purpan (Toulouse). Journal d’Economie Médicale 2003; 21: 367–76Google Scholar
- 34.Weill A, Chinaud F, Vallier N, et al. Fréquence et coûts des trente affections de longue durée de la région Midi-Pyrénées, anné e 2003. Rev Med Ass Maladie 2005; 36: 273–87Google Scholar