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Cost of HIV and determinants of health care costs in HIV-positive patients in Germany: results of the DAGNÄ K3A Study

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Abstract

Objectives

The aims of this study were to estimate the expenditure for HIV-care in Germany and to identify variables associated with resource use.

Design/setting

We performed an 18-month prospective multi-center study in an HIV specialized ambulatory care setting from 2006 to 2009.

Subjects, participants

Patients were eligible for study participation if they (1) were HIV-positive, (2) were ≥18 years of age, (3) provided written consent and (4) were not enrolled in another clinical study; 518 patients from 17 centers were included.

Main outcome measures

Health care costs were estimated following a micro-costing approach from two perspectives: (1) costs incurred to society in general, and (2) costs incurred to statutory health insurance. Data were obtained using questionnaires. Several empirical models for identifying the relationship between health care costs and independent variables, including age, gender, route of transmission and CD4 cell count at baseline, were developed.

Results

Average annual health care costs were €23,298 per patient from the societal perspective and €19,103 from the statutory health insurance perspective. Most expenses are caused by antiretroviral medication (80 % of the total and 89 % of direct costs), while hospital costs represented 7 % of total expenditure. A statistically significant association was found between health care costs and clinical variables, with higher CD4 count and female gender generating lower costs, while increased antiretroviral experience and injection drug use led to higher expenditures (P < 0.05).

Conclusions

Expenditures for HIV-infection are driven mainly by drug costs. We identified several clinical variables influencing the costs of HIV-treatment. This information could assist policymakers when allocating limited health care resources to HIV care.

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Acknowledgments

The authors thank Prof. Dr. Matthias Stoll for reviewing the manuscript and providing invaluable comments. This work was funded through unconditional grants from the following pharmaceutical companies: Abbott GmbH & Co. KG, Boehringer Ingelheim Pharma GmbH & Co. KG, Gilead Sciences GmbH, Roche Pharma AG, Glaxo Smith Kline GmbH & Co. KG, Pfizer Pharma GmbH, Bristol-Myers Squibb GmbH & Co. KGaA and Tibotec Division of Janssen-Cilag GmbH.

Author information

Authors and Affiliations

  1. Institute for Health Care Management and Research, University of Duisburg-Essen, Schützenbahn 70, 45127, Essen, Germany

    Sarah Mostardt, Jürgen Wasem & Anja Neumann

  2. DAGNÄ e.V, German Association of Physicians Specialized in HIV Care e.V., Berlin, Germany

    Nikola Hanhoff, Armin Goetzenich, Knud Schewe, Christoph Mayr, Hans Jaeger & Stephan Dupke

  3. ICH Study Center, Hamburg, Germany

    Knud Schewe

  4. MUC Research, Munich, Germany

    Eva Wolf

  5. Ärzteforum, Seestrasse, Berlin, Germany

    Christoph Mayr

  6. MVZ Karlsplatz - HIV Research and Clinical Care Center, Munich, Germany

    Hans Jaeger

  7. Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR) and Zentrum für Versorgungsforschung Köln (ZVFK), Cologne, Germany

    Holger Pfaff

  8. Schwerpunktpraxis, Berlin, Germany

    Stephan Dupke

Authors
  1. Sarah Mostardt
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  2. Nikola Hanhoff
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  3. Jürgen Wasem
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  4. Armin Goetzenich
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  5. Knud Schewe
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  6. Eva Wolf
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  9. Holger Pfaff
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  10. Stephan Dupke
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  11. Anja Neumann
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Corresponding author

Correspondence to Sarah Mostardt.

Additional information

Knud Schewe, Eva Wolf, Christoph Mayr, Hans Jaeger, Stephan Dupke represent the German K3A Study group. Details of the German K3A Study group are given in “Appendix”.

Appendix

Appendix

The German K3A Study Group:

  • Axel Adam-Carl Knud Schewe/Lutwin Weitner, Hamburg

  • Axel Baumgarten/Andreas Carganico/Stephan Dupke, Berlin

  • Stefan Esser, Essen

  • Ifi-Institut Andreas Plettenberg/Albrecht Stoehr, Hamburg

  • Eva Jägel-Guedes/Hans Jäger, München

  • Heribert Knechten, Aachen

  • Hans Heiken/Stefanie Holm/Birger Kuhlmann, Hannover

  • Amina Carlebach/Peter Gute/Leo Locher/Thomas Lutz, Frankfurt a.M.

  • Christoph Athmann/Petra Hegener/Stefan Mauss/Günther Schmutz, Düsseldorf

  • Christoph Mayr/Wolfgang Schmidt, Berlin

  • Jürgen Brust/Manfred Hensel/Christoph Plöger/Dieter Schuster, Mannheim

  • Schmidt Reinhold E., Hannover

  • Edith Ißler/Andreas Schaffert/Eiko Schnaitmann/Andreas Trein, Stuttgart

  • Schlomo Staszewski, Frankfurt a.M.

  • Thomas Buhk/Stefan Fenske/Hans-Jürgen Stellbrink, Hamburg

  • Susanne Usadel, Freiburg

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Mostardt, S., Hanhoff, N., Wasem, J. et al. Cost of HIV and determinants of health care costs in HIV-positive patients in Germany: results of the DAGNÄ K3A Study. Eur J Health Econ 14, 799–808 (2013). https://doi.org/10.1007/s10198-012-0425-4

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  • DOI: https://doi.org/10.1007/s10198-012-0425-4

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