title: Analysis of contemporary HIV/AIDS health care costs in Germany: Driving factors and distribution across antiretroviral therapy lines.
abstract: To analyze contemporary costs of HIV health care and the cost distribution across lines of combination antiretroviral therapy (cART). To identify variations in expenditures with patient characteristics and to identify main cost determinants. To compute cost ratios between patients with varying characteristics.Empirical data on costs are collected in Germany within a 2-year prospective observational noninterventional multicenter study. The database contains information for 1154 HIV-infected patients from 8 medical centers.Means and standard deviations of the total costs are estimated for each cost fraction and across cART lines and regimens. The costs are regressed against various patient characteristics using a generalized linear model. Relative costs are calculated using the resultant coefficients.The average annual total costs (SD) per patient are &OV0556;22,231.03 (8786.13) with a maximum of &OV0556;83,970. cART medication is the major cost fraction (83.8%) with a mean of &OV0556;18,688.62 (5289.48). The major cost-driving factors are cART regimen, CD4-T cell count, cART drug resistance, and concomitant diseases. Viral load, pathology tests, and demographics have no significant impact. Standard non-nucleoside reverse transcriptase inhibitor-based regimens induce 28% lower total costs compared with standard PI/r regimens. Resistance to 3 or more antiretroviral classes induces a significant increase in costs.HIV treatment in Germany continues to be expensive. Majority of costs are attributable to cART. Main cost determinants are CD4-T cells count, comorbidity, genotypic antiviral resistance, and therapy regimen. Combinations of characteristics associated with higher expenditures enhance the increasing effect on the costs and induce high cost cases.
authors.affiliation: aCenter for Health Economics Research Hannover, Hannover bSektion Klinische Infektiologie, Med IV, Klinikum der Universität München, Munich cID-Ambulanz der Medizinischen Klinik Nord, Klinikum Dortmund, Dortmund dInnere Medizin, Praxis Georgstraße, Hannover eICH Grindel, Infektionsmedizinisches Centrum Hamburg, Hamburg fHealth Economics & Pricing, Janssen-Cilag GmbH, Neuss gKlinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Germany.
authors.forename: Marina
authors.initials: M
authors.lastname: Treskova
authors.forename: Alexander
authors.initials: A
authors.lastname: Kuhlmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Bogner
authors.forename: Martin
authors.initials: M
authors.lastname: Hower
authors.forename: Hans
authors.initials: H
authors.lastname: Heiken
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Stellbrink
authors.forename: Jörg
authors.initials: J
authors.lastname: Mahlich
authors.forename: Johann-Matthias Graf von der
authors.initials: JM
authors.lastname: Schulenburg
authors.forename: Matthias
authors.initials: M
authors.lastname: Stoll
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics* / Q000628:therapy*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D005858:Germany; D015658:HIV Infections / Q000191:economics / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents