HAART (zidovudina, lamivudina, indinavir): analisi dei costi in una popolazione di pazienti HIV positivi con conta linfocitaria CD4+ < 200/mmc
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Objective To analyze the cost of a population of HIV patients with less than 200 CD4 cell count treated with HAART (highly active antiretroviral therapy).
Design Retrospective study
Setting IRCCS Policlinico S. Matteo Pavia, Italy, University of Pavia, Italy.
Patients and participants 181 HIV positive patients with less than 200 CD4 cell count observed from January 1996 until December 1997.
Main outcome measures Hospitalization, days of stay, AIDS definig events, deaths, direct cost, assessed during two years follow-up.
Results During follow-up hospitalizations decreased from 154 to 118, while hospital stays dropped from 3429 to 2832 days, with the decrease beginning at the start of the 2nd four-month period of 1997. There was a reduction in terms of time of AIDS defining events (ADE) compared to those of 1996; in 1997 there was a 70% decrease in new diagnoses. Likewise, for deaths, there was a constant decrease in 1997 when compared to 1996 where there was a peak in the third four-month period. Total costs of our patient cohort were similar for 1996 and 1997, with a shift occurring from hospitalization costs to anti-retroviral therapy costs.
Conclusion Our data indicate that patients with CD4 < 200/mmc, that is that population carrying the greatest health costs, does not result in relevant added costs when HAART is used (plus 10% on pro-capite for year bases) but, rather, creates a shift from one type of cost to another.
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