Abstract
To calculate the cost of Human Immunodeficiency Virus (HIV) patients treated with Anti-Retroviral therapy (ARV) including medications, hospitalizations, tests, and specialist visits over a 12 months follow-up period, 3 Italian Local Health Units databases were analysed. All records (patients ≥18 years) between January 1, 2008 and December 31, 2009 associated with nucleoside analogue reverse-transcriptase inhibitor (NRTI), non-nucleoside analogue reverse-transcriptase inhibitor (NNRTI), protease inhibitor (PI), or other drugs in ATC J05A group, were included. Data and costs were collected for medications, hospitalizations, diagnostic tests, and specialist visits for the 12 months after the first ARV prescription (follow-up). Records of treatment for the 24 month prior to the first ARV prescription were classified as naïve or experienced. Costs-per-unit for resource use were collected from DRGs, National Tariffs and Drugs Formulary. A total of 779 records were analyzed 515 male (46.4±9.7years) and 264 female (42.0±9.2years). Records were classified as naïve (12,7%) and experienced (87,3%). The most prescribed regimens were Efavirenz+Tenofovir/Emtricitabine (TDF/FTC) (22.1%), Atazanavir±ritonavir(r)+ TDF/FTC (17.2%), and Lopinavir/r+TDF/FTC (11.2%). No switching of therapy during the follow-up was found in 78.2% of the records. Amid non-switcher records, the annual average total cost (medications, hospitalizations, tests, and specialist visits) was €9,103.82±5,302.11, including €7,099.70 for ARV therapy (77%), €631.65 for HIV-related hospitalizations (7%), and €551.49 for HIV-related diagnostic tests/specialist visits (6%). Total costs for Efavirenz+TDF/FTC, Atazanavir±r+TDF/FTC and Lopinavir/r+TDF/FTC regimens amounted to 7,637.40€, 11,257.00€ and 9,426.94€ respectively, with higher total costs being associated with Atazanavir±r+TDF/FTC. In this administrative databases analysis, the annual total average cost of HIV patients was significantly influenced by specific ARV medications, suggesting that total cost of therapies could differ significantly from drug acquisition cost of a single drug. A payer's perspective should include all direct costs and not only drug acquisition costs.
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