Use and cost of antiretrovirals in France 1995-2000: an analysis based on the Medical Dossier on Human Immunodeficiency (release 2) database.
OBJECTIVE
To assess the temporal relationship between the uptake of more aggressive antiretroviral (ARV) therapy and the use and cost of hospital treatment for HIV-infected patients in France from 1995 to 2000 from a hospital perspective.


METHODS
Analysis of evolutions in health status (CD4+ cell count, transition to AIDS and mortality) and components of hospital treatment (inpatient hospitalisation, outpatient consultations, day hospital stays and hospital ARV prescriptions) based on a sample of 2203 patients in 30 French hospitals, using data from the French Medical Dossier on Human Immunodeficiency (release 2) database. Health status and healthcare consumption were measured per patient and per semester from 1995 to 2000 inclusive, with unit costs applied to resource data (1999 values). Results were stratified for gravity of illness.


RESULTS
Between 1995 and 2000, there was an overall improvement in health status for HIV-infected patients. The mortality rate dropped by 82% and the incidence of cases of transition to AIDS fell significantly. Over the same period, the proportion of patients on ARV treatment grew from 69.5% to 97%, with a large rise in the use of polytherapy. The increase was most notable for patients with CD4+ cell counts above 500 cells/mm3, in whom the ARV prescription rate rose from 29% to 96% by 2000. This brought ARV expenditure from Euro 637 per patient per semester in 1995 up to Euro 2042 in 2000, an increase of 220%. Inpatient hospitalisation rates fell by 60% and average length of stay decreased, bringing down total hospital costs (excluding ARVs) from Euro 5179 per patient in the first semester of 1995 to Euro 2314 in 2000 (a 55.5% reduction). Total expenditure per patient per semester therefore fell from Euro 5817 to Euro 4356, a 25% decrease.


CONCLUSIONS
The wider use of multiple combination ARV therapy in France is temporally related to an improvement in the health status of HIV-infected patients, accompanied by reduced consumption of hospital care.
Flori
Yves A
YA
Cregas Inserm U537, Paris, France. Yves-Antoine.Flori@isped.u-bordeaux2.fr
le Vaillant
Marc
M
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D004469:Economics, Hospital; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans
D044966:Anti-Retroviral Agents