Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands

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 af...

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Published in:PloS one Vol. 18; no. 2; p. e0280877
Main Authors: 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
Format: Journal Article
Language:English
Published: United States Public Library of Science 08.02.2023
Public Library of Science (PLoS)
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Anti-HIV Agents - therapeutic use
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiviral agents
Biological products industry
Biology and Life Sciences
Care and treatment
CD4 antigen
CD4 Lymphocyte Count
Clinics
Consent
Cost assessments
Costs
Data collection
Drugs
Economic aspects
Europe
Evaluation
Health aspects
Health Care Costs
Health risks
Highly active antiretroviral therapy
HIV
HIV (Viruses)
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV testing
Hospitalization
Human immunodeficiency virus
Humans
Infections
Laboratories
Laboratory tests
Medical care, Cost of
Medical diagnosis
Medicine and Health Sciences
Morbidity
Mortality
Netherlands
Netherlands - epidemiology
Patient outcomes
Public health
United States
Netherlands
Europe
United States
ISSN:1932-6203, 1932-6203
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Summary: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. 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). 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. 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.
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Competing Interests: DvdV reports unrestricted research grant from Gilead Sciences, Merck Sharp & Dohm, ViiV and Janssen Pharmaceuticals. CAB reports personal fees from speaker honoraria from ViiV outside the submitted work; AvS reports grants from Dutch Ministry of Health, Welfare and Sport, during the conduct of the study; grants from European Centre for Disease Prevention and Control, outside the submitted work. PR reports independent scientific grant support from Gilead Sciences, Merck Sharp & Dohm, and ViiV Healthcare through his institution; scientific advisory board participation for Gilead Sciences, ViiV Healthcare, Merck Sharp & Dohm., and Teva Pharmaceutical Industries Ltd., for which his institution has received remuneration. SP, LV, BN, SG, AV have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Data can be shared upon request to the corresponding author.
Membership of the ATHENA observational cohort is listed in the Acknowledgments.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0280877