, Volume 22, Issue 16, pp 1061–1070 | Cite as

Use and cost of antiretrovirals in France 1995–2000

An analysis based on the medical dossier on human immunodeficiency (release 2) database
  • Yves A. Flori
  • Marc le Vaillant
Original Research Article


Objective: To assess the temporal relationship between the uptake of more aggressive antiretroviral (ARV) therapy and the use and cost of hospital treatment for HIV-infected patients in France from 1995 to 2000 from a hospital perspective.

Methods: Analysis of evolutions in health status (CD4+ cell count, transition to AIDS and mortality) and components of hospital treatment (inpatient hospitalisation, outpatient consultations, day hospital stays and hospital ARV prescriptions) based on a sample of 2203 patients in 30 French hospitals, using data from the French Medical Dossier on Human Immunodeficiency (release 2) database. Health status and healthcare consumption were measured per patient and per semester from 1995 to 2000 inclusive, with unit costs applied to resource data (1999 values). Results were stratified for gravity of illness.

Results: Between 1995 and 2000, there was an overall improvement in health status for HIV-infected patients. The mortality rate dropped by 82% and the incidence of cases of transition to AIDS fell significantly. Over the same period, the proportion of patients on ARV treatment grew from 69.5% to 97%, with a large rise in the use of polytherapy. The increase was most notable for patients with CD4+ cell counts above 500 cells/mm3, in whom the ARV prescription rate rose from 29% to 96% by 2000. This brought ARV expenditure from €637 per patient per semester in 1995 up to €2042 in 2000, an increase of 220%. Inpatient hospitalisation rates fell by 60% and average length of stay decreased, bringing down total hospital costs (excluding ARVs) from €5179 per patient in the first semester of 1995 to €2314 in 2000 (a 55.5% reduction). Total expenditure per patient per semester therefore fell from €5817 to €4356, a 25% decrease.

Conclusion: The wider use of multiple combination ARV therapy in France is temporally related to an improvement in the health status of HIV-infected patients, accompanied by reduced consumption of hospital care.


Triple Therapy Hospital Treatment Quadruple Therapy French Hospital Hospital Spending 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was financed by a grant from the French National Agency on AIDS research (ANRS). The authors acknowledge the three anonymous referees for their comments.

The authors have no potential conflicts of interest directly relevant to the content of this study.


  1. 1.
    Ministère de l’emploi et de la solidarité. Les chiffres clés: sida et hépatite C. Paris: Flammarion Médecine-Science, 1999Google Scholar
  2. 2.
    Anis AIL Hoggs RS, Wang X, et al. Modelling the potential economic impact of viral-load driven drug combination antiretroviral drug therapy. Pharmacoeconomics 1998; 13: 697–705PubMedCrossRefGoogle Scholar
  3. 3.
    Chatterton ML, Scott-Lennox J, Wu AW, et al. Quality of life and treatment satisfaction after the addition of lamivudine or lamivudine plus loviride to zidovudine-containing regimens in treatment-experienced patients with HIV infection. Pharmacoeconomics 1999; 15 Suppl. 1: 67–74CrossRefGoogle Scholar
  4. 4.
    Lacey L, Hopkinson PK, Montaner J, et al. An evaluation of the cost effectiveness of adding lamivudine to zidovudine-containing regimens in HIV Infection. Pharmacoeconomics 1999; 15 Suppl. 1: 55–66CrossRefGoogle Scholar
  5. 5.
    Youle M, Trueman P, Simpson K. Health economics in HIV disease: a review of the European literature. Pharmacoeconomics 1999; 15 Suppl. 1: 1–12PubMedCrossRefGoogle Scholar
  6. 6.
    Richter A, Brandeau M, Owens D. An analysis of optimal resource allocation for prevention of infection with human immunodeficiency virus in injection drugs users and nonusers. Med Decis Making 1999; 19: 167–79PubMedCrossRefGoogle Scholar
  7. 7.
    Freedberg KA, Losina E, Weinstein MC, et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med 2001; 344: 824–31PubMedCrossRefGoogle Scholar
  8. 8.
    Beck EJ, Tolley K, Power A, et al. The use and cost of HIV service provision in England in 1996. Pharmacoeconomics 1998; 13: 639–52CrossRefGoogle Scholar
  9. 9.
    Beck EJ, Flori YA, Geofard PY, et al. Uptake of combination antiretroviral therapy during 1996 and 1997: an Anglo-French comparison. [Abstract 42289] 12th World AIDS Conference; 1998 Jun 28-Jul 3; Geneva. IAS, 1998Google Scholar
  10. 10.
    Anis AIL Hogg RS, Yip B, et al. Average annual drug cost and its determinants in a population based cohort of HIV positive adult men and women. Pharmacoeconomics 1998; 13: 327–36PubMedCrossRefGoogle Scholar
  11. 11.
    Carpenter CCJ, Cooper DA, Fishl MA, et al. Antiretroviral therapy in adults: updated recommendations of the International AIDS Society, USA Panel. JAMA 2000; 283: 381–90PubMedCrossRefGoogle Scholar
  12. 12.
    Delfraissy IF, editor. Prise en charge thérapeutique des personnes infectées par le VIH. Paris: Ministere de (emploi et de la solidarité, 1999, 2000Google Scholar
  13. 13.
    Beck EJ, Miners AIL Tolley K. The Cost of HIV treatment and care: a global review. Pharmacoeconomics 2001; 19: 13–59PubMedCrossRefGoogle Scholar
  14. 14.
    Kerleau M, Le Vaillant M, Flori YA. Measuring the variability of prescription use in patients with HIV infection or AIDS. Pharmacoeconomics 1997; 12: 246–61CrossRefGoogle Scholar
  15. 15.
    Beck EJ, Mandalia S, Williams L, et al. Decreased morbidity and use of hospital services in English HIV-infected individuals with increased uptake of anti-retroviral therapy 1996-1997. AIDS 1999; 13: 2157–64PubMedCrossRefGoogle Scholar
  16. 16.
    Mouton Y, Alfandari S, Valette M, et al. Impact of protease inhibitors on AIDS-defining events and hospitalisations in 10 French AIDS reference centres. Fédération Nationale des Centres de Lutte contre le SIDA. AIDS 1997; 11: F101–5PubMedCrossRefGoogle Scholar
  17. 17.
    Lavalle C, Aguilar JC, Peña F, et al. Reduction in hospitalization costs, morbidity, disability, and mortality in patients with AIDS treated with protease inhibitors. Arch Med Res 2000; 31: 515–9PubMedCrossRefGoogle Scholar
  18. 18.
    Velasco M, Gómez A, Fernández C, et al. Economic impact of HIV protease inhibitor therapy in the global use of health-care resources. HIV Med 2000; 1: 246–51PubMedCrossRefGoogle Scholar
  19. 19.
    Floridia M, Massella M, Bucciardini R, et al. Hospitalizations and costs of treatment for protease inhibitor-based regimens in patients with very advanced HIV-infection (CD4 < 50/mm3). HIV Clin Trials 2000; 1: 9–16PubMedCrossRefGoogle Scholar
  20. 20.
    Gebo KA, Chaisson RE, Folkemer JG, et al. Costs of HIV medical care in the era of highly active antiretroviral therapy. AIDS 1999; 13: 963–9PubMedCrossRefGoogle Scholar
  21. 21.
    Garattini L, Tediosi F, Di Cintio E, et al. Resource utilization and hospital cost of HIV/AIDS care in Italy in the era of highly active antiretroviral therapy. AIDS Care 2001; 13: 733–41PubMedCrossRefGoogle Scholar
  22. 22.
    Bidwell Goetz M, Morreale AP, Rhew DC, et al. Effect of highly active antiretroviral therapy on outcomes in Veterans Affairs Medical Centers. AIDS 2001; 15: 530–2PubMedCrossRefGoogle Scholar
  23. 23.
    Kyriopoulos JE, Geitona MA, Paparizos VA, et al. The impact of new antiretroic therapeutic schemes on the cost for AIDS treatment in Greece. J Med Syst 2001; 25: 73–80PubMedCrossRefGoogle Scholar
  24. 24.
    Dormont J, editor. Prise en charge thérapeutique des personnel infectées par le VIH. Paris: Ministère de la santé, 1997Google Scholar
  25. 25.
    Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1997Google Scholar
  26. 26.
    Tolley K, Gyldmark M. The treatment and care cost of people with HIV infection or AIDS: development of a standardised cost framework for Europe. Health Policy 1993; 24: 55–70PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  1. 1.Cregas Inserm U537ParisFrance
  2. 2.Institut de Santé Publique d’ Épidémiologie et de Développement (ISPED)University of BordeauxBordeauxFrance

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