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Adherence can cause increase in direct ART and health care costs
Study highlights short-term impact
At least in the short-term, higher adherence can lead to higher direct health care costs in treating HIV patients, researchers reveal.
The findings apply only to actual costs and do not include the benefits associated with improvements in quality of life or whether patients who were more adherent were more productive in society.
It also did not look at any estimated costs from HIV prevention related to adherent ART use, says Edward M. Gardner, MD, an infectious diseases physician at Denver Public Health in Denver, CO, and an assistant professor in the department of medicine/division of infectious diseases of the University of Colorado Denver in Aurora, CO.
Gardner and co-investigators studied how adherence impacted ART and health care costs among HIV patients.1
"Cost effectiveness analyses take into account prolonging lives, quality of life, and people being able to return to work, and that's not included in this analysis," he explains. "People are living longer, happier, but there's no way to assess this with retrospective data."
"We agree with all of the studies that show ART is cost-effective," Gardner says. "But the other studies have never taken into account adherence in their cost-effectiveness analyses, and we wanted to see if adherence could affect the cost ratio."
They found that people who were more adherent had higher expenses for drugs because they took more medications.
"The cost of being more adherent, the excess cost in therapy, was greater in magnitude than the cost savings from decreased hospitalization and decreased outpatient visits," Gardner says. "In our study, we followed patients over three years."
Research that follows patients for a longer period of time might find that these results are reversed, he notes.
"This is the longest study that's ever looked at this issue by far, but if you were to look at it over 10 years and take into account more opportunistic infections and hospitalizations among people who were less adherent, then you might not find what we found," Gardner adds.
The second highest expense for HIV patients was outpatient and clinic visits, including psychiatric care, emergency room visits, outpatient labs, x-rays, etc., Gardner says.
It's difficult to determine ART costs because an ADAP in one state might pay considerably more or less for drugs than an ADAP in another state, and they're both paying to the same companies, he says.
"It seems like there should be more transparency in pricing," he adds. "I was unable to find the real bottom line."
And while everyone can understand how important it is to reward pharmaceutical companies for their long and expensive research and innovation, it's still difficult to understand the wide disparity between what developing nations pay for these regimens versus what is paid in the United States, Gardner says.
"You look at some other countries that can get the same regimen for $200 that we spend $12,000 per year on," he says.
"There doesn't seem to be an end in sight to new drugs dominating the market, and for good reason because they're easier to take, have less side effects, and are more potent," Gardner adds. "And there's no end in sight to the costs we're seeing."