التفاصيل البيبلوغرافية
| العنوان: |
Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands. |
| المؤلفون: |
Popping, Stephanie, Versteegh, Lisbeth, Nichols, Brooke E., van de Vijver, David A. M. C., van Sighem, Ard, Reiss, Peter, Geerlings, Suzanne, Boucher, Charles A. B., Verbon, Annelies |
| المصدر: |
PLoS ONE; 2/8/2023, Vol. 17 Issue 2, p1-15, 15p |
| مصطلحات موضوعية: |
HIV, MEDICAL care costs, HIV-positive persons |
| مصطلحات جغرافية: |
NETHERLANDS, SUB-Saharan Africa |
| مستخلص: |
Introduction: In Europe, half of people living with HIV (PLWH) present late to care, with associated higher morbidity and mortality. This study aims to assess short- and long-term costs of HIV-care based on time of presentation and identify other factors contributing to higher costs in the first and fifth year after antiretroviral therapy (ART) initiation. Material and methods: We included ATHENA cohort data which prospectively includes 98% of PLWH in the Netherlands. PLWH who initiated ART in 2013 were included and followed over five years. PLWH were divided in three categories based on CD4 cell-count at time of ART initiation: timely presentation (CD4>350cells/μL), late presentation (CD4 200-350cells/μL or >350cells/μL with AIDS-defining illness) and very late presentation (CD4<200cells/μL). The total HIV-care cost was calculated distinguishing ART medication and non-ART medication costs (hospitalization, outpatient clinic visits, co-medications, and HIV-laboratory tests). Results: From 1,296 PLWH, 273 (21%) presented late and 179 (14%) very late. Nearly half of those who entered HIV-care in a very late stage were of non-Dutch origin, with 21% originating from sub-Saharan Africa. The mean cost per patient in the first year was €12,902 (SD€11,098), of which about two-thirds due to ART (€8,250 (SD€3,142)). ART costs in the first and fifth year were comparable regardless of time of presentation. During the first year on treatment, non-ART medication costs were substantially higher among those with late presentation (€4,749 (SD€8,009)) and very late presentation (€15,886 (SD€ 21,834)), compared with timely presentation (€2,407(SD€4,511)). Higher non-ART costs were attributable to hospitalization and co-medication. The total non-ART costs incurred across five years on treatment were 56% and 246% higher for late and very late presentation respectively as compared to timely presentation. Conclusion: Very late presentation is associated with substantial costs, with non-ART costs nearly seven times higher than for those presenting timely. Hospitalization and co-medication costs are likely to continue to drive higher costs for individuals with late presentation into the future. Programs that identify individuals earlier will therefore likely provide significant short- and long-term health cost savings. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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