Cost of human immunodeficiency virus infection in Italy, 2007–2009: effective and expensive, are the new drugs worthwhile?

Giuliano Rizzardini,¹ Umberto Restelli,² Paolo Bonfanti,³ Emanuele Porazzi,² Elena Ricci,¹ Emanuela Foglia,² Laura Carenzi,¹ Davide Croce<sup>2

1</sup>First Infectious Diseases Department, "Luigi Sacco" Hospital, Milan; ²Centre for Research on Health Economics, Social, and Health Care Management, Università Carlo Cattaneo, Castellanza; ³Infectious Diseases Department, "Alessandro Manzoni" Hospital, Lecco, Italy

Background: In recent years, the increased efficacy and effectiveness of antiretroviral treatment has led to longer survival of patients infected with human immunodeficiency virus (HIV), but has also raised the question of what happens to consumption of resources. Early highly active antiretroviral treatment (HAART), management of hepatitis C virus (HCV) coinfection, and expensive newly marketed drugs may affect the economic sustainability of treatment from the point of view of the National Healthcare Services. The present study aimed to provide information on the economic burden of HIV-positive patients resident in the Lombardy region using a three-year time horizon.
Methods: This was a retrospective, observational, budget impact study, based on information collected for the period 2007–2009, including hospitalizations, outpatient services, and HAART and non-HAART drug utilization. Patients with confirmed HIV infection, aged ≥ 18 years, resident in the Lombardy region, and followed at the "L Sacco" Hospital in Milan from 2007 to 2009 were eligible.
Results: A total of 483 patients (mean age 44.1 years) were included in the study. The mean CD4+ cell count increased over the study period from 462 ± 242 cells/mm³ in 2007, to 513 ± 267 cells/mm³ in 2008, to 547 ± 262 cells/mm³ in 2009. In total, 162 subjects (33.5%) were coinfected with HCV. Hospitalizations and HAART costs increased from 2007 to 2009, whereas outpatient visits and non-HAART drug costs decreased slightly over time. The total cost increase was also significant when limiting the analysis to experienced patients, HCV-negative patients, and experienced HCV-negative patients.
Conclusion: CD4+ cell count, a major predictor of costs, increased over the study period. However, immunological improvement was achieved by greater expense in the short term. Whether this may be compensated by a long-term decrease in opportunistic infections and in the costs of management of HIV-related events is an area still to be investigated.

Keywords: health care costs, human immunodeficiency virus infection, risk factors, retrospective study