Early scale-up of antiretroviral therapy at diagnosis for reducing economic burden of cardiometabolic disease in HIV-infected population (original) (raw)

AIDS, 2020

Abstract

OBJECTIVE This study aims to assess the effect of early scale-up of antiretroviral therapy (ART) at HIV diagnosis on the economic burden of cardiometabolic diseases (CMDs) in HIV-infected population. DESIGN cohort study. METHODS The study cohort comprised 10,693 newly diagnosed HIV patients without CMDs before HIV diagnosis identified from a nationwide HIV cohort in Taiwan. The patients were stratified by ART use (medication possession ratio [MPR] ≥0.8: [high] vs. <0.8: [low]) and AIDS-defining illnesses (ADI) status (present: [+] vs. absent: [-]) at the first year of HIV diagnosis into four groups: ART (low) & ADI (-), ART (low) & ADI (+), ART (high) & ADI (-), and ART (high) & ADI (+). The economic analysis of incident CMDs was from the perspective of Taiwan's single-payer healthcare system and estimated using generalized estimating equations. RESULTS CMDs significantly increased annual direct medical costs by 31% (hypertension) to 127% (cardiovascular diseases [CVDs]). The annual cost burden of diabetes, dyslipidemia, and CVDs in the ART (high) & ADI (-) group significantly decreased by 42%, 30%, and 31%, respectively, compared to the ART (low) & ADI (+) group. Compared to the ART (low) & ADI (+) group, the annual cost burden of CVDs in the ART (high) & ADI (-) and ART (high) & ADI (+) groups decreased by 31% and 14%, respectively, suggesting increased cost-savings when ART is initiated at diagnosis before ADI occurrence. CONCLUSIONS The early scale-up of ART at diagnosis before ADI occurrence is important for minimizing the economic burden of incident CMDs among HIV-infected patients.

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