Economic evaluation of HIV treatments: the I.CO.N.A. cohort study.
OBJECTIVE
To describe the changes in costs of care for HIV-positive patients in Italy after the spread of antiretroviral combination therapies (HAART).


METHODS
Five thousand four hundred and twenty-two patients from the I.CO.N.A. (Italian Cohort Naive Antiretrovirals) study were followed between 1997 and 2002. Costs included antiretroviral therapies (ART), hospital admissions, prophylaxis, and main laboratory examinations. The perspective was that of the National Health Service.


RESULTS
Admission costs per person-year decreased from 2148 euro in 1997 to 256 in 2002, while the average annual costs of ART increased from 2145 to 3149 euro (1997 prices). From 1997 to 1999, ART costs increased from 42.3 to 85.9% of the total, while admission costs decreased from 42.3 to 7.0% and prophylaxis from 7.3 to 1.7%. The breakdown of ART costs shows how dual therapies decreased over time in favor of HAART, falling from 26.8% in 1997 to 5.9% in 2002. Patients with fewer than five treatment switches had the lowest costs distributions over the entire observation period.


CONCLUSIONS
From 1997 to 2002 inpatient costs progressively decreased in favor of antiretroviral therapy. Annual average costs per patient decreased, while total direct costs increased over time: health resources, initially concentrated on hospitalized patients were then distributed over a growing number of subjects.
Merito
Monica
M
Laboratory of Economics and Management, Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà 33, 56127 Pisa, Italia. merito@sssup.it
Bonaccorsi
Andrea
A
Pammolli
Fabio
F
Riccaboni
Massimo
M
Baio
Gianluca
G
Arici
Claudio
C
Monforte
Antonella D'Arminio
AD
Pezzotti
Patrizio
P
Corsini
Dario
D
Tramarin
Andrea
A
Cauda
Roberto
R
Colangeli
Vincenzo
V
Pastore
Giuseppe
G
D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D015658:HIV Infections / Q000188:drug therapy*; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D007558:Italy; D009313:National Health Programs