title: Cost analysis of pharmaceutical care provided to HIV-infected patients: an ambispective controlled study.
abstract: BACKGROUND
  Studies have shown that pharmaceutical care can result in favorable clinical outcomes in human immunodeficiency virus (HIV)-infected patients, however, few studies have assessed the economic impact. The objective of this study was to evaluate the clinical and economic impact of pharmaceutical care of HIV-infected patients.
  
  
  METHODS
  A controlled ambispective study was conducted in Brazil from January 2009 to June 2012. Patients were allocated to either intervention or control group. The control group was followed according to standard care while the intervention group was also followed by a pharmacist at each physician appointment for one year. Effectiveness outcomes included CD4+ count, viral load, absence of co-infections and optimal immune response, and economic outcomes included expenses of physician and pharmaceutical appointments, laboratory tests, procedures, and hospitalizations, at six months and one year.
  
  
  RESULTS
  Intervention and control groups included 51 patients each. We observed significant decreases in total pharmacotherapy problems during the study. At six months, the intervention group contained higher percentages of patients without co-infections and of patients with CD4+ >500 cells/mm(3). None of the differences between intervention and control group considering clinical outcomes and costs were statistically significant. However, at one year, the intervention group showed higher percentage of better clinical outcomes and generated lower spending (not to procedures). An additional health care system daily investment of US$1.45, 1.09, 2.13, 4.35, 1.09, and 0.87 would be required for each additional outcome of viral load <50 copies/ml, absence of co-infection, CD4+ >200, 350, and 500 cells/mm(3), and optimal immune response, respectively.
  
  
  CONCLUSIONS
  This work demonstrated that pharmaceutical care of HIV-infected patients, for a one-year period, was able to decrease the number of pharmacotherapy problems. However, the clinical outcomes and the costs did not have statistical difference but showed higher percentage of better clinical outcomes and lower costs for some items.
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), Alexander Fleming, 105, 13083-881, Campinas, SP, Brazil. recarnevale@yahoo.com.br.
authors.forename: Renata Cavalcanti
authors.initials: RC
authors.lastname: Carnevale
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), Alexander Fleming, 105, 13083-881, Campinas, SP, Brazil. carolgodoi@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: de Godoi Rezende Costa Molino
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), Alexander Fleming, 105, 13083-881, Campinas, SP, Brazil. mariberlofa@gmail.com.
authors.forename: Marília Berlofa
authors.initials: MB
authors.lastname: Visacri
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), Alexander Fleming, 105, 13083-881, Campinas, SP, Brazil. pmazzola@fcm.unicamp.br.
authors.forename: Priscila Gava
authors.initials: PG
authors.lastname: Mazzola
authors.affiliation: Department of Clinical Pathology, Faculty of Medical Sciences (FCM), University of Campinas (UNICAMP), Alexander Fleming, 105, 13083-881, Campinas, SP, Brazil. morielpa@fcm.unicamp.br.|Faculty of Pharmaceutical Sciences (FCF), University of Campinas (UNICAMP), Sérgio Buarque de Holanda, 25, 13083-859, Campinas, SP, Brazil. morielpa@fcm.unicamp.br.
authors.forename: Patricia
authors.initials: P
authors.lastname: Moriel
mesh_terms: D000328:Adult; D001938:Brazil; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000191:economics*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome