Abstract
Objective: To estimate indirect costs in Spanish ambulatory patients with HIV/AIDS and to identify changes in employment status and their current QOL.
Method: Information was obtained through 32 interviews/enquiries carried out with ambulatory patients receiving medical attention at Gregorio Marañón and Puerta de Hierro hospitals in Madrid, Spain. The study variables included information on sociodemographics, economics, and clinical and QOL (EuroQol instrument; EQ-5D) parameters of these patients.
Results: Our main result showed the existence of high indirect costs (lost income and lost wages; 2002 values) at the individual level. We identified a strong effect in terms of income loss (the annual loss of income ranged between €5271 and €6150 per patient) and lost wages (the annual loss of wages ranged between €7537 and €8793 per patient). We also observed a strong impact on household income (the annual loss of household income ranged between €6693 and €7813). There was a great variability in these costs among the patients depending on their QOL, gender and education. We detected a statistically significant and positive correlation between QOL and having a job.
Conclusions: We observed a high level of QOL among the patients, which reflects the potential benefits of pharmacological treatment. We found that the better the QOL, the higher the probability of being employed. However, indirect costs were high among patients despite their good QOL.
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References
Fauci AS. The AIDS Epidemic: considerations for the 21st century. N Engl J Med 1999; 341: 1046–50
Casabona J. Sida o infectión por VIH? Implicaciones sanitarias. Med Clin (Bare) 1999; 112: 335–6
Ojo K, Delaney M. Economic and demographic consequences of AIDS in Namibia: rapid assessment of the costs. Int J Health Plann Manage 1997; 12: 315–26
Cabasés Hita JM. Cuánto nos cuesta el Sida? Med Clin (Bare) 1995; 104: 573–5
Beck EJ, Miners AIL, Tolley K. The cost of HIV treatment and care: a global review. Pharmacoeconomics 2001 Jan; 19 (1): 13–39
HIV/AIDS. A threat to decent work, productivity and development (2000). Document for discussion at the Special HighLevel Meeting on HIV/AIDS and the World of Work; 2000 Jun 8; Geneva. ILO (International Labour Organization). SafeWork — Programme on HIV/AIDS. Available from URL: www.ilo.org/public/english/protection/trav/aids/publ/threatdecentworkeng.pdf [Accessed 2003 Aug]
Spanish Ministry of Health and Consumer Affairs. Epidemiologia. Available from URL: http://www.mse.es/sida/epidemio-logia/home.htm [Accessed 2003 Aug 6]
Castilla J, De la Fuente L. Evolución del número de personas infectadas por el virus de la inmunodeficiencia humana y de los casos de sida en España: 1980–1998. Med Clin (Bare) 2000; 115: 85–9
Encuesta hospitalaria sobre la utilización de recursos y caracteristicas de los pacientes VIH/sida. Madrid: Ministerio de Sanidad y Consumo, 1998 Nov
Antonanzas VF, Anton F, Juarez C, et al. Cálculos de los costes del sida en España mediante técnicas de simulación. Med Clin (Bare) 1995; 104: 568–72
Mompo C, Abbas I, Santin M, et al. La utilización de recursos sanitarios en pacientes infectados por el VIH: creation de una base de datos y obtención de resultados de costes. Gac Sanit 2000 Enero/febrero; 14 (1): 39–47
Pinto JL, Lopez Lavid C, Badia X, et al. Análisis coste efec-tividad del tratamiento antirretroviral de gran actividad en pacientes infectados por el VIII asintomáticos. Med Clin (Bare) 2000; 114 Suppl. 3: 62–7
Gebo KA, Chaisson RE, Folkemer JG, et al. Costs of HIV medical care in the era of highly active antiretroviral therapy. AIDS 1999 May 28; 13 (8): 963–9
Kahn JG, Marseille E. Fighting global AIDS: the value of cost-effectiveness analysis. AIDS 2000 Nov 10; 14 (16): 2609–10
Lapins DL, Urdaneta ME, Barrett J, et al. Costs of care for HIV infection in a managed care population from 1995 to 1997. Am J Manag Care 2000 Sep; 6 (9): 973–81
Wallace MR, Tasker SA, Shinohara YT, et al. The changing economics of HIV care. AIDS Patient Care STDS 2001 Jan; 15 (1): 25–9
Sendi P, Palmer AJ, Gafni A, et al. Highly active antiretroviral therapy: pharmacoeconomic issues in the management of HIV infection. Pharmacoeconomics 2001; 19 (7): 709–13
Oliva J. La valoración de los costes indirectos en la evaluation sanitaria. Med Clin (Bare) 2000; 114 Suppl. 3: 15–21
Mullins CD, Whitelaw G, Cooke JL, et al. Indirect cost of HIV infection in England. Clin Ther 2000 Nov; 22 (11): 1333–45
Sendi PP, Bücher HC, Harr T, et al. Cost effectiveness of highly active antiretroviral therapy in HIV-infected patients. AIDS 1999; 13: 1115–22
Freedberg KA, Losina E, Weinstein MC, et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med 2001; 344 (11): 824–31
Johannesson M. The willingness to pay for health changes, the human-capital approach and the external costs. Health Policy 1996; 36: 232–44
Posnett J, Jan S. Indirect cost in economic evaluation: the opportunity cost of unpaid inputs. Health Econ 1996; 5: 13–23
Pinto JL, Puig-Junoy J. El coste de oportunidad del tiempo remunerado en la production [working paper]. Madrid: Funda-ción BBVA, 2001
Liljas B. How to calculate indirect costs in economic evaluation. Pharmacoeconomics 1998; 13 (1): 1–7
Patella Jr FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998; 338 (13): 853–60
Freedberg KA, Losina E, Weinstein MC, et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med 2001; 344 (11): 824–31
Canadian Coordinating Office for Health Technology Assessment. Guidelines for economic evaluation of pharmaceutical: Canada. 2nd ed. Ottawa (ON): Canadian Office for Health Technology Assessment (COOHTA), 1997
Johannesson M, Jönsson B, Karlsson G. Outcome measurement in economic evaluation. Health Econ 1996; 5: 279–96
Acknowledgements
We would like to thank Indalecio Corugedo, Álvaro Hidalgo, Jaume Puig, Dr Jesús Millán, Dr Emilio Bouza, Dr Dolores Montserrat, Dr Teodoro Martín, Dr María Sanjurjo, Dr Isabel Castillo, Dr Lourdes Caro, Alicia Coduras, Carmen López-Lavid and Gonzalo Nocea and three anonymous referees for their comments.
This study has received unconditional support from Merck, Sharp & Dohme de España, S. A.
Juan Oliva thanks the scholarship granted by The Merck Company Foundation, the philanthropic branch of Merck & Co. Inc., White House Station, New Jersey, USA, for providing the opportunity to attend the congress organised by the Spanish Health Economics Association held in Oviedo in 2001.
The authors have no conflicts of interest that are directly relevant to the content of this manuscript.
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Oliva, J., Roa, C. & del Llano, J. Indirect costs in ambulatory patients with HIV/AIDS in Spain. Pharmacoeconomic 21, 1113–1121 (2003). https://doi.org/10.2165/00019053-200321150-00005
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DOI: https://doi.org/10.2165/00019053-200321150-00005