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Adherence to HIV Treatment and Costs of Care FREE

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The summary below is from the full report titled “Association of Antiretroviral Therapy Adherence and Health Care Costs.” It is in the 5 January 2010 issue of Annals of Internal Medicine (volume 152, pages 18-25). The authors are J.B. Nachega, R. Leisegang, D. Bishai, H. Nguyen, M. Hislop, S. Cleary, L. Regensberg, and G. Maartens.

Ann Intern Med. 2010;152(1):I-50. doi:10.7326/0003-4819-152-1-201001050-00003
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What is the problem and what is known about it so far?

Human immunodeficiency virus (HIV) infection interferes with the body's ability to fight infections and some types of cancer. Therapy to fight HIV is called antiretroviral therapy (ART). Combination therapies with antiretroviral drugs have been shown to increase length of life in many persons with AIDS. Combination therapy usually consists of taking 3 or 4 drugs of different types at the same time. Each of these drugs works against HIV in a different way. Adherence, which means taking drugs exactly as prescribed, can be difficult with ART. However, patients who take ART exactly as prescribed do better than those who miss doses. It is not known whether patients with good adherence to ART also have lower health care costs than those with poor adherence.

Why did the researchers do this particular study?

To see whether patients with good adherence to ART for HIV infection had higher or lower health care costs than those with poor adherence.

Who was studied?

6833 HIV-infected adults who were enrolled in a special AIDS program in South Africa and started ART between 6 August 2000 and 30 April 2006. The AIDS program paid for care, including ART, and provided recommendations for treatment. However, patients received care from their own doctors.

How was the study done?

Using pharmacy data, the researchers classified each patient's level of ART adherence according to how frequently he or she filled prescriptions for the drugs. They then compared various health care costs for patients with different levels of ART adherence. The types of costs they examined included those for drugs, doctor visits, laboratory tests, and hospital care.

What did the researchers find?

Total average monthly costs decreased as adherence increased. The largest differences in costs were related to hospital care.

What were the limitations of the study?

This special program may not reflect what happens in other settings. The study did not include indirect costs, such as those related to time out of work.

What are the implications of the study?

Good adherence to HIV therapy not only improves patient outcomes but also seems to be associated with lower health care costs.





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