The Cost of HIV Disease in Northern Italy: The Payer's Perspective

Abstract

Healthcare expenditures incurred by the Health Service for HIV-infected patients have not been reported in Italy. To present health care costs for HIV-infected patients in the Lombardy Region, in 2004-2007, to determine the clinical characteristics of HIV infection associated with costs. Retrospective, observational, budget impact study, based on information collected for the period 2004-2007, including hospitalizations, outpatient services, highly active antiretroviral therapy (HAART) and non-HAART drug utilization. Inclusion criteria includes: confirmed HIV infection, age ≥18 years, resident in Lombardy Region, and followed at the "L. Sacco" Hospital in Milan from 2004 to 2007. The mean total cost per year to provide healthcare to HIV-positive patients was rather stable (€ 9658.36 in 2004 and € 9745.65 in 2007 (+0.90%)); HAART represented more than 60% of the total cost. We found that hepatitis C virus coinfection was related to higher costs (€ 11,003.45 vs. € 8896.06), as well as CD4 cell count <200 cells/mm (€ 12,681.36 vs. € 9594.11 and € 9450.36 in 200-499 and ≥500 cells/mm, respectively). The mean total cost of HIV health care was higher in patients who initiated antiretroviral treatment before 1997 than in those who started after 1996. The mean total cost per year to provide health care to HIV-positive patients was stable during the period 2004-2007, with an increase of HAART percentage impact on the total cost. Several clinical characteristics of HIV-infected patients were significantly associated with cost variation.