Newer drugs and earlier treatment: impact on lifetime cost of care for HIV-infected adults.
Newer drugs and earlier treatment: impact on lifetime cost of care for HIV-infected adults.
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DOI：
10.1097/qad.0b013e32834dce6e
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发表时间：
2012-01-02
期刊：
影响因子：
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通讯作者：
Cost-Effectiveness of Preventing AIDS Complications (CEPAC) investigators
中科院分区：
文献类型：
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作者：
Sloan CE;Champenois K;Choisy P;Losina E;Walensky RP;Schackman BR;Ajana F;Melliez H;Paltiel AD;Freedberg KA;Yazdanpanah Y;Cost-Effectiveness of Preventing AIDS Complications (CEPAC) investigators
确定护理的组成成本，以优化有限资源的治疗。我们使用预防艾滋病并发症的艾滋病毒疾病和治疗的成本效益模型来预测预期寿命（LE）以及未贴现和贴现的终身成本（2010欧元）。我们确定了1998年至2005年在法国北部北方艾滋病毒感染的成年人的医疗资源利用。每月HIV费用按CD 4计数分层。CD 4、HIV RNA和基因型检测以及抗逆转录病毒治疗（ART）的费用来自已发表的文献。来自国家数据的模型输入包括平均年龄38岁，平均初始CD 4计数372/µl，在CD 4计数<350/µl时开始ART，ART方案费用从760欧元/月到2，570欧元/月不等。该模型预测平均未贴现LE为26.5年，终生未贴现成本为535，000欧元/患者（贴现320，700欧元）; 73%的成本与ART相关。当患者接受治疗时平均CD 4计数为510/µl，并在CD 4计数<500/µl或HIV RNA > 100，000拷贝/ml时开始ART时，LE为27.4年，费用增加1- 2%，达到546，700欧元（折扣324，500欧元）。当我们假设引入仿制药将导致一线ART成本下降50%时，终身成本下降4- 6%，为514，200欧元（折扣302，800欧元）。随着艾滋病毒疾病得到更有效药物的早期治疗，生存率和护理费用将继续增加。在高收入国家提供广泛使用的非专利抗逆转录病毒药物可以降低这些费用。
To determine the component costs of care to optimize treatment with limited resources. 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€). 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/µl, ART initiation at CD4 counts <350/µl, and ART regimen costs ranging from €760/month to €2,570/month. The model projected a mean undiscounted LE of 26.5 years and a lifetime undiscounted cost of €535,000/patient (€320,700 discounted); 73% of costs were ART-related. When patients presented to care with mean CD4 counts of 510/µl and initiated ART at CD4 counts <500/µl or HIV RNA >100,000 copies/ml, LE was 27.4 years and costs increased 1–2%, to €546,700 (€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 €514,200 (€302,800 discounted). 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.