Costs and benefits of HAART for patients with HIV in a public hospital in Mexico.
BACKGROUND
The Mexican government is currently implementing strategies to improve and expand comprehensive treatment for people living with HIV. Limited data, however, are available on the benefits obtained and costs incurred by these strategies.


OBJECTIVE
To estimate the effects of highly active antiretroviral therapy (HAART) on a cohort of people living with HIV and to estimate the cost of extending patients' lives.


METHODS
A survival analysis was used to follow a dynamic cohort of 797 people receiving AIDS treatment in Mexico from 1982 to 2006. The Kaplan-Meier method was applied to estimate the probability of survival for different lengths of time starting on the date of diagnosis. The Cox's proportional hazards regression model was used to assess differences in AIDS mortality by antiretroviral therapy regimen, age and sex.


RESULTS
The probability of survival after diagnosis without antiretroviral therapy (ART) was approximately 0.73 (95% CI 0.69-0.77) after the first year, 0.36 (95% CI 0.32-0.40) at 5 years, 0.28 (95% CI 0.24-0.33) at the tenth year, 0.26 (95% CI 0.21-0.31) at the fifteenth year and 0.22 (95% CI 0.14-0.30) thereafter. The results showed a longer life expectancy when patients took HAART (as opposed to monotherapy or dual therapy) from the beginning of their treatment. Results from the Cox model showed that those who started and continued on HAART were 7.1 (P < 0.01) times more likely to survive than those who received no treatment. Extending the length of life beyond 15 years after the initial diagnosis represents an accumulated cost of more than US$280,000.00 per individual.
Aracena-Genao
Belkis
B
Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. baracena@corre.insp.mx
Navarro
Jesús Oaxaca
JO
Lamadrid-Figueroa
Hector
H
Forsythe
Steven
S
Trejo-Valdivia
Belem
B
D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D015497:HIV-1; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013995:Time
D044966:Anti-Retroviral Agents