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Newer drugs and earlier treatment: Impact on lifetime cost of care for HIV-infected adults
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POST ACCEPTANCE, 15 October 2011
Sloan, C.E.; Champenois, K.; Choisy, P.; Losina, E.; Walensky, R.P.; Schackman, B.R.; Ajana, F.; Melliez, H.; Paltiel, A.D.; Freedberg, K.A.; Yazdanpanah, Y.; For the Cost-Effectiveness of Preventing AIDS complications (CEPAC) investigators
from Jules: I'm not sure this study includes costs associated with comorbidities like bone, CVD, diabetes, neurologic disease etc. and of course housing etc.

"Our study
demonstrates that total lifetime costs of care have
increased, but that the overall annual costs of care have
remained remarkably stable over time. The main driver of
the increase in total lifetime costs of care is the dramatic
improvement in survival generated by both earlier ART
initiation and more efficacious treatment."


Objective: To determine the component costs of care to optimize treatment with limited resources.

Design: We used the Cost-Effectiveness of Preventing AIDS Complications Model of HIV disease and treatment to project life expectancy (LE) and both undiscounted and discounted lifetime costs (2010[Euro sign]).

Methods: We determined medical resource utilization among HIV-infected adults followed from 1998 to 2005 in Northern France. Monthly HIV costs were stratified by CD4 count. Costs of CD4, HIV RNA and genotype tests and antiretroviral therapy (ART) were derived from published literature. Model inputs from national data included mean age 38 years, mean initial CD4 count 372/[mu]l, ART initiation at CD4 counts <350/[mu]l, and ART regimen costs ranging from [Euro sign]760/month to [Euro sign]2,570/month.

Results: The model projected a mean undiscounted LE of 26.5 years and a lifetime undiscounted cost of [Euro sign]535,000/patient ([Euro sign]320,700 discounted); 73% of costs were ART-related. When patients presented to care with mean CD4 counts of 510/[mu]l and initiated ART at CD4 counts <500/[mu]l or HIV RNA >100,000 copies/ml, LE was 27.4 years and costs increased 1-2%, to [Euro sign]546,700 ([Euro sign]324,500 discounted). When we assumed introducing generic drugs would result in a 50% decline in first-line ART costs, lifetime costs decreased 4-6%, to [Euro sign]514,200 ([Euro sign]302,800 discounted).

Conclusions: As HIV disease is treated earlier with more efficacious drugs, survival and thus costs of care will continue to increase. The availability in high-income countries of widely-used antiretroviral drugs in generic form could reduce these costs.
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