The association of adherence to antiretroviral therapy with healthcare utilization and costs for medical care

Gardner, Edward M.; Maravi, Moises; Rietmeijer, Cornelis A.; Davidson, Arthur J.; Burman, William J.

doi:10.1007/bf03256129

Cited by 34 publications

(25 citation statements)

References 38 publications

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“…In contrast, in a U.S. study by Gardner et al [69], better adherence to cART was associated with higher direct medical costs despite lower rates of hospitalization in more adherent individuals. The differences in the relative contribution of cART costs to overall costs probably accounts for the apparent discrepancy among the studies conducted in South-Africa (where the cART cost component accounted only for 9% of total costs) and in the U.S. (where ART costs represent 60% of total costs).…”

Section: Non-adherence To Antiretroviral Therapy and Its Impact Onmentioning

confidence: 86%

“…The data discussed above showed that in resource-limited settings, where cART comprises a smaller proportion of overall health care costs, excellent adherence to antiretroviral therapy is cost saving [68]. In resource rich settings, better adherence decreases health care utilization, but is not cost saving [69]. However, it is important to note that no formal cost-effectiveness analyses of adherence to antiretroviral therapy have been completed to date.…”

Section: Non-adherence To Antiretroviral Therapy and Its Impact Onmentioning

confidence: 99%

See 1 more Smart Citation

HIV Treatment Adherence, Drug Resistance, Virologic Failure: Evolving Concepts

Nachega

Marconi

Zyl

et al. 2011

IDDT

224

149

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Poor adherence to combined antiretroviral therapy (cART) has been shown to be a major determinant of virologic failure, emergence of drug resistant virus, disease progression, hospitalizations, mortality, and health care costs. While high adherence levels can be achieved in both resource-rich and resource-limited settings following initiation of cART, long-term adherence remains a challenge regardless of available resources. Barriers to optimal adherence may originate from individual (biological, socio-cultural, behavioral), pharmacological, and societal factors. Although patients and providers should continuously strive for maximum adherence to cART, there is accumulating evidence that each class of antiretroviral therapy has specific adherence-drug resistance relationship characteristics allowing certain regimens more flexibility than others. There is not a universally accepted measure for cART adherence, since each method has distinct advantages and disadvantages including cost, complexity, accuracy, precision, intrusiveness and bias. Development of a real-time cART adherence monitoring tool will enable the development of novel, pre-emptive adherence-improving strategies. The application of these strategies may ultimately prove to be the most cost-effective method to reduce morbidity and mortality for the individual and decrease the likelihood of HIV transmission and emergence of resistance in the community.

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Section: Non-adherence To Antiretroviral Therapy and Its Impact Onmentioning

confidence: 86%

Section: Non-adherence To Antiretroviral Therapy and Its Impact Onmentioning

confidence: 99%

HIV Treatment Adherence, Drug Resistance, Virologic Failure: Evolving Concepts

Nachega

Marconi

Zyl

et al. 2011

IDDT

224

149

View full text Add to dashboard Cite

show abstract

“…The total estimated cost of the service in 2012 was €973 ppm, nearly 90% of which was due to the cost of HAART. While it is difficult to compare costs across countries, HAART is reported to account for 60%-80% of the total cost of HIV care (including inpatient care) in many studies in developed countries [27-33]. …”

Section: Discussionmentioning

confidence: 99%

Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

Brennan

Jackson

Horgan

et al. 2015

BMC Health Serv Res

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BackgroundIt is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications.MethodsA micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Ireland. The costs of individual appointment types were estimated based on staff grade and time. Hospital resources used by HIV patients who attended the ambulatory care service in 2012 were identified and extracted from existing hospital systems. Associations between patient characteristics and costs per patient month, in 2012 euros, were examined using univariate and multivariate analyses.ResultsThe average cost of providing ambulatory HIV care was found to be €973 (95% confidence interval €938 - €1008) per patient month in 2012. Sensitivity analysis, varying the base-case staff time estimates by 20% and diagnostic testing costs by 60%, estimated the average cost to vary from a low of €927 per patient month to a high of €1019 per patient month. The vast majority of costs were due to the cost of HAART. Women were found to have significantly higher HAART costs per patient month while patients over 50 years of age had significantly lower HAART costs using multivariate analysis.ConclusionsThis study provides the estimated cost of ambulatory care in a regional HIV centre in Ireland. These data are valuable for planning services at a local level, and the identification of patient factors, such as age and gender, associated with resource use is of interest both nationally and internationally for the long-term planning of HIV care provision.

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“…In addition to sexual risk behaviors, it is increasingly recognized that poor adherence to antiretroviral therapy (ART), and to HIV clinical care and treatment more generally, is associated with higher risk of HIV transmission due to failure to suppress HIV viral levels to undetectable levels [12–15]. Poor adherence is also associated with poorer clinical outcomes for PLWHA [16–18] and has high societal costs (e.g., tertiary treatment, lost productivity) [19, 20]. Adherence to care and treatment remains a challenge for many HIV infected patients [9, 21,22] and deserves attention in secondary HIV prevention efforts.…”

Section: Introductionmentioning

confidence: 99%

Mental Health Treatment to Reduce HIV Transmission Risk Behavior: A Positive Prevention Model

et al. 2009

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Secondary HIV prevention, or "positive prevention," is concerned with reducing HIV transmission risk behavior and optimizing the health and quality of life of people living with HIV/AIDS (PLWHA). The association between mental health and HIV transmission risk (i.e., sexual risk and poor medication adherence) is well established, although most of this evidence is observational. Further, a number of efficacious mental health treatments are available for PLWHA yet few positive prevention interventions integrate mental health treatment. We propose that mental health treatment, including behavioral and pharmacologic interventions, can lead to reductions in HIV transmission risk behavior and should be a core component of secondary HIV prevention. We present a conceptual model and recommendations to guide future research on the effect of mental health treatment on HIV transmission risk behavior among PLWHA.

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The association of adherence to antiretroviral therapy with healthcare utilization and costs for medical care

Abstract: Background-The association between antiretroviral adherence, healthcare utilization and medical costs has not been well studied.

Cited by 34 publications

References 38 publications

HIV Treatment Adherence, Drug Resistance, Virologic Failure: Evolving Concepts

HIV Treatment Adherence, Drug Resistance, Virologic Failure: Evolving Concepts

Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

Mental Health Treatment to Reduce HIV Transmission Risk Behavior: A Positive Prevention Model

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