[Antiretroviral pharmaceutical expenditure and possibilities for optimization].
BACKGROUND
A lack of treatment compliance, resistances and non-advanced stages of the disease are the reasons why not all HIV-infected patients benefit from the demonstrated efficacy of antiretroviral drug combinations--with the consequent important increase in costs. A prospective cohort follow-up study is conducted to analyze the distribution of antiretroviral pharmaceutical expenditure in a district hospital, and the possibilities for improving its efficiency.


METHODS
The study comprised 128 HIV-infected patients seen for 12 consecutive weeks (September to November, 2004). The characteristics of previous follow-up were analyzed, and the patients were divided into groups according to the course over the following weeks and the results of prescribed treatment: group 1 (effective treatment), group 2 (ineffective treatment), and group 3 (treatment dropout). Based on the prescription history, corroborated with drug retrieval and the acquisition costs (FARMASYS software), the cost of antiretroviral medication was calculated for each of the 108 patients receiving highly active antiretroviral therapy (HAART). The statistical analysis was carried out with the SPSS version 11.5 statistical package, and considering statistical significance for p < 0.05.


RESULTS
The cost generated by the 108 patients included during the study period who received HAART was 232,366 euros, with an average of 2,151 euros per patient and 19,363 euros per day of consultation. The distribution of patients and of the costs generated by the above defined groups was as follows: group 1: 79 patients (80.6%); group 2: 11 patients (10.6%); group 3: 18 patients (8.8%). In the group 1 patients, 15.2% of the antiretroviral expenditure corresponded to patients who had started therapy with a CD4+ count of > 350 cells/ml, while 45% had > 350 cells/ml at the present time, and 25.9% had > 500 cells/ml. Previous medication dropout was identified as a predictor of new dropouts and treatment failures.


CONCLUSIONS
While the cost generated by antiretroviral medication is high, 19.4% is administered to patients who do not benefit from such treatment due to a lack of efficacy or dropouts, and in another 40-60% of cases the need for such treatment could be subject to consideration in view of the good immune status of the patients.
Tornero Estebanez
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C
Servicio de Medicina Interna, Hospital Francisco de Borja, Gandia, Valencia. tornero_cas@gua.es
Cuenca Soria
A
A
Nolasco Bonmatí
A
A
Soler Company
E
E
Rull Segura
S
S
D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D015331:Cohort Studies; D016527:Drug Costs; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D006769:Hospitals, General; D006801:Humans; D008297:Male; D013030:Spain; D016312:Treatment Refusal
D044966:Anti-Retroviral Agents