[Public health economic aspects of antiretroviral therapy. Can we afford to do less?].
In Germany, politically motivated economic considerations are becoming even more important. In this connection, scientific research into the health system is not limited merely to a consideration of costs, but utilizes the same methods and conceptual models as economic research in general to investigate defined problems. The reduction of illness-related loss of production and quality of life to monetary units in the models used, often stimulates critical discussions of the ethical permissibility of such an approach. Public discussion of such models then makes it possible to justify rationally founded allocation decisions and to expose and thus prevent hidden forms of rationing. The medically successful concept of long-term administration of highly active antiretroviral combination treatment (HAART) was first considered by numerous studies to be cost-effective solely on the basis of the saving of inpatient treatment costs--a stance that in the light of the life-shortening HIV infection should not be thought to be only basis for the decision. Owing to a lack of experience with the long-term prognosis under HAART, it is difficult to assess indirect costs for HIV infection. An assessment of the quality of life in the symptom-free stages of HIV infection depends largely on coping strategies, so that the results of studies on quality of life measurement under antiretroviral treatment must not lightly be interpreted as a function of a given therapeutic strategy. Given the high costs of HIV infection to the economy, the marked reluctance to provide the necessary funding for research in the area of epidemiological monitoring, specific preventive measures and vaccination strategies is to be regretted.
Stoll
M
M
Abteilung Klinische Immunologie, Medizinischen Hochschule Hannover. Stoll.Matthias@Mh-Hannover.de
Claes
C
C
Schulte
E
E
Körner
T
T
von der Schulenburg
J M
JM
Schmidt
R
R
D019380:Anti-HIV Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005858:Germany; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D009313:National Health Programs / Q000191:economics*; D011788:Quality of Life
D019380:Anti-HIV Agents
Gesundheitsökonomische Aspekte der antiretroviralen Therapie. Können wir uns leisten, weniger zu tun?