Early Treatment in HIV Patients: A Cost–Utility Analysis from the Italian Perspective

Marcellusi, Andrea; Viti, Raffaella; Russo, Simone; Andreoni, Massimo; Antinori, Andrea; Mennini, Francesco Saverio

doi:10.1007/s40261-016-0382-2

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…On the other side, several studies are showing that the number of HIV-related hospitalizations has decreased in recent years, primarily because of the availability of cART and, consequently, because of the declining of the incidence of advanced HIV cases [ 9 – 11 ]. Although antiretroviral therapy is expensive, its cost-effectiveness has been demonstrated in several analyses [ 12 – 14 ]. Given the opposite trend in expenditure drivers (drugs vs hospitalizations), detailed cost analyses are crucial to measure economic cost-offset.…”

Section: Introductionmentioning

confidence: 99%

How has the cost of antiretroviral therapy changed over the years? A database analysis in Italy

Taramasso

Demma

Bitonti

et al. 2018

BMC Health Serv Res

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BackgroundThe number of human immunodeficiency virus (HIV)-related hospitalizations has decreased worldwide in recent years, due to the availability of combined antiretroviral therapies (cART). The present analysis aimed to analyse the economic, and clinical burden of HIV management, after the introduction of systematic use of cART.MethodsData from HIV-infected patients, treated at Policlinico San Martino Hospital in Genova (Italy) were retrospectively collected. A comparison between years 2009 and 2015 was performed. HIV-related admissions were identified by using the Diagnosis-Related Group (DRG) codes. The resource consumption of outpatient services was derived by using a modelling approach. Expenditure for drugs was also analysed, as aggregate data.ResultsThe number of HIV-infected patients was 898 in 2009 and 1006 in 2015. Overall, the virological success rate improved from 2009 to 2015, as the percentage of patients with HIV-RNA < 50 copies/mL increased from 79 to 89% (P < 0.05). The average incidence of hospitalizations per-patient decreased from 0.30 in 2009, to 0.13 in 2015. Average expenditure per-patient decreased from €10,107 in 2009 to €9063 in 2015.ConclusionsThe present analysis confirmed the role of cART in controlling HIV viral load and, consequently, in reducing hospitalizations, admissions to day-hospital and the use of outpatient services.Clinical improvements and economic savings more than compensated the investments required to treat HIV-infected patients with cART. Health Authorities should invest in modern cART supply and universal treatment, to use at best the available resources and obtain a cost-effective improvement of health in people living with HIV. Additional research, with the involvement of different centers and the use of patient-specific data, are recommended to consolidate the findings of this analysis.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3507-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

How has the cost of antiretroviral therapy changed over the years? A database analysis in Italy

Taramasso

Demma

Bitonti

et al. 2018

BMC Health Serv Res

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“…The benefits of early treatment are now well recognized [ 33 ]: the 5-year risk of clinical progression is 3.2% in people starting cART immediately versus 7% in those deferring [ 34 ]. Rapid cART initiation is known to confer a significantly enhanced 2 year probability of immunological recovery, independently from baseline CD4+ count, and minimized HIV-associated inflammation [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Proportion and factors associated with recent HIV infection in a cohort of patients seen for care in Italy over 1996-2014: Data from the ICONA Foundation Study cohort

et al. 2017

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In Italy the prevalence of recent HIV infection (RHI) isn’t currently monitored. Early diagnosis is crucial to allow introduction of antiretroviral therapy (cART) in the recent phase of infection. We aimed to estimate the proportion and the determinants of RHI among patients enrolled in the ICONA cohort; we explored differences in the median time from HIV diagnosis to cART initiation and in the viro-immunological response between RHI and Less Recent HIV infections (NRHI). We included antiretroviral-naïve HIV-positive patients enrolled in the cohort with documented dates of HIV-negative and positive antibodies tests, grouped in RHI (estimated date of seroconversion within 12 months of enrolment) and NRHI. Proportion of RHI and the trend of this proportion by calendar period (1996–2014) were investigated (Chi-square test). Logistic regression analysis was employed to identify factors associated with RHI. The time from seroconversion to cART initiation was compared in RHI and NRHI overall and after stratification by calendar period (survival analysis). We finally explored the time from starting cART to HIV-RNA <50 copies/mL and to CD4+ gain ≥200 cells/mmc by Cox regression. HIV seroconversion could be estimated for 2608/12,616 patients: 981/2608 (37.6%) were RHI. Proportion of RHI increased in recent calendar periods and was associated with younger age, baseline higher HIV-RNA and CD4+ count. There wasn’t difference in the 2-year estimates of cART start between RHI and NRHI, regardless of calendar period. Rates and hazards of virological response were similar in RHI versus NRHI. RHI showed a 1.5-fold higher probability of CD4+ gain, also following adjustment for calendar period and cART regimen, and for age, HCV and smoking; the difference in probability was however attenuated after further controlling for baseline HIV-RNA and CD4+ T-cells. The increased proportion of RHI over time suggests that in recent years in Italy HIV infections are more likely to be detected earlier than before. The similar rates of cART introduction and viro-immunological response in RHI and NRHI probably reflect the efficacy of the modern cART regimens. An improvement of the prevention services is warranted to allow an early cART access, also in the perspective of therapy as prevention.

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“…L’analisi è stata condotta mediante l’adattamento di un modello di Markov precedentemente pubblicato in letteratura ( 8 , 9 ). Le simulazioni sono state condotte considerando la possibilità di un trattamento continuo per i pazienti già diagnosticati (non si prevedono interruzioni terapeutiche) e un inizio immediato dei pazienti con nuova diagnosi nel corso del 2021.…”

Section: Metodiunclassified

“…L’analisi ha previsto la simulazione della coorte dei pazienti affetti da HIV in Italia secondo un orizzonte temporale di 10 anni e il processo di Markov è stato simulato secondo la struttura a stati discreti già presentata in letteratura ( Fig. 1 ) ( 8 , 9 ). In particolare, ciascuna coorte di pazienti con infezione da HIV risulta caratterizzata da una determinata stratificazione per livello di CD4 che ne definisce la gravità ( Tab.…”

Section: Struttura Del Modellounclassified

Evaluation of epidemiological and economic consequences due to the delay in treatment of hiv-positive patients caused by the covid-19 pandemic

Marcellusi

Bini

Andreoni

et al. 2021

Grhta

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Objective: To assess, from an epidemiological and economic point of view, the consequences of the reduction in the supply of antiretroviral drugs due to the COVID-19 pandemic. Method: The analysis was conducted by adapting a Markov model previously published in literature. The simulations were conducted considering the possibility of continuous treatment for patients already diagnosed (no therapeutic interruptions are expected) and an immediate start of patients with new diagnosis during 2021. This analysis was compared with a scenario involving a therapeutic interruption or diagnostic delay caused by COVID-19. Results: The analysis showed that the scenario characterized by a treatment delay, compared to the scenario of early resumption of therapy, could generate an increase in the number of patients with CD4 < 200 equal to 1,719 subjects (+16%) and a reduction in the number of patients with CD4 500 equal to 6,751 (−9%). A timely resumption of treatment for HIV+ patients could prevent 296, 454 and 687 deaths in the third, fifth and tenth years of analysis respectively with a potential cost reduction equal to 78,9 million at a 10 year time horizon. Conclusions: These findings show that it is essential, especially in a pandemic situation such as the present one, to introduce technological, digital and organizational solutions, aimed at promoting timely diagnosis and at accelerating the therapeutic switch for patients who are no longer targeted.

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Early Treatment in HIV Patients: A Cost–Utility Analysis from the Italian Perspective

Cited by 6 publications

References 31 publications

How has the cost of antiretroviral therapy changed over the years? A database analysis in Italy

How has the cost of antiretroviral therapy changed over the years? A database analysis in Italy

Proportion and factors associated with recent HIV infection in a cohort of patients seen for care in Italy over 1996-2014: Data from the ICONA Foundation Study cohort

Evaluation of epidemiological and economic consequences due to the delay in treatment of hiv-positive patients caused by the covid-19 pandemic

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