A multicentre study of patient survival, disability, quality of life and cost of care
Objective: To describe the epidemiological, clinical and economic changes that occurred in the HIV epidemic in Italy prior to and after the introduction of highly active antiretroviral therapy (HAART).
Design: A prospective, observational, multicentre case-control study was conducted comparing data, collected over 6 months, from an AIDS cohort in 1998 with that of a cohort in 1994. Out of 77 patients with AIDS in the 1998 cohort, 74 survived. These 74 patients were matched for severity of illness with 74 patient survivors from the 1994 cohort to enable valid comparisons of mortality, disability-dependency (DD), health-related QOL (HR-QOL), and direct costs.
Results: Overall, a considerable difference was observed in mortality (33.8% in 1994 vs 3.9% in 1998) between unmatched patients of the two cohorts. As for matched patients, the number of hospital admissions was 1.7 in 1994 and 0.8 in 1998; the average length of stay was 28.1 days in 1994 and 12.6 days in 1998. The direct cost per patient per year was €15 390 and €11 465 for the 1994 and 1998 cohorts, respectively (1999 values). The 1998 patient cohort had significantly better HR-QOL at 6 months in two domains of the instrument used (emotional reaction and energy) and the percentage of totally dependent patients was significantly lower compared with the 1994 cohort (1.4% vs 6.8%).
Conclusions: This is the first study to present a comprehensive comparison of direct costs, DD and HR-QOL of patients with AIDS between two time periods. The use of a case-control design has enabled changes in costs and outcomes to be linked to the introduction of HAART in Italy in 1997.
KeywordsNottingham Health Profile Observational Study Design Total Direct Medical Cost Pragmatic Randomise Control Trial Unmatched Patient
The 1998 study (The Palladio study) has been partly supported by Merck Sharp & Dohme S. p. A., Italy. The authors have no conflicts of interest that are directly or indirectly relevant to the content of this manuscript.
The authors gratefully acknowledge the contributions of Dr Dongping Yin (MSD S.p.A.) for his assistance and JM Bos (GUIDE/GRIP) for the critical review of the paper.
- 7.Lapins D, Hamel E, Barret J, et al. Cost of HIV care in the era of combination therapy [abstract PO 460–737]. 39th ICAAC; 1999 Sep 26–29; San FranciscoGoogle Scholar
- 11.Aggiornamento dei casi di AIDS notificati in Italia al 30 Giugno 2000. Notiziario dell’Istituto Superiore di SanitA 2000; 13 (11): 1–12Google Scholar
- 12.Alonso J, Hunt S, Niero M, and the European Group for Quality of Life and Health Measurement. European guide to the Nottingham health profile. D Bucquet, editor. France: Montpellier, 1992Google Scholar
- 13.Wilking D, Thompson C. User’s guide to dependency measures for elderly people: social service monograph 1989. Sheffield: Joint Unit for Social Services Research, University of Sheffield, 1989Google Scholar
- 17.Scitovsky AA. Studying the cost of HIV-related illnesses: reflection on the moving target. Milbank Q 1989; 673: 18–44Google Scholar
- 24.Taroni F, Anemona A per it gruppo di Studio AN. CO. L’assistenza ospedaliera per i pazienti con AIDS in Italia. GIAIDS 1993; 1: 2–15Google Scholar
- 25.Torti C, Casari S, Palvarini L, et al. Modifications of health resource-use in Italy after the introduction of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection. Pharmacoeconomic implications in a population-based setting. Health Policy 2003 Sep; 65 (3): 261–7PubMedCrossRefGoogle Scholar
- 27.Revicky DA, Moyle G, Stellbrink HJ, et al. Quality of life outcomes of combination zalcitabine-zidovudine, saquinavir-zidovudine and saquinavir-zalcitabine-zidovudinetherapy for HIV-infected adults with CD4 cell count between 50 and 350 per cubic millimeter. AIDS 1999; 13: 851–8CrossRefGoogle Scholar