HAART has been shown to be cost effective by preventing disease progression and the necessity for concomitant treatment. New antiretrovirals (ARVs) and more complex HAART-combinations are more expensive than in prior periods and thus the economic impact of HAART is rising. This demands increasing efforts for rational data based decisions to allocate resources. Objective:
To evaluate direct costs of HAART in patients treated at specialised clinical centers. Methods:
Analysis of the complete HAART documentation from 23 centers of the German ClinSurv cohort. ART-regimens were calculated individually using documented start and stop dates for each ARV between Jan-1996 and Jun-2008. Direct costs of HAART were calculated as office-based sales prices. Results:
Overall 18.4 million treatment-days in 10,499 individuals have been evaluated. Mean observed duration under HAART was 1,765 days. Within the observed 12 year follow-up period overall costs of €703,700,000 have been accumulated. Average daily costs of an entire regimen are €38.29. Discounted (4% p.a.) office based daily drug-regimen (DDD) costs have been doubled since 1996 (+107%). But this increase is caused predominantly by the introduction of triple-HAART from 1996-98 (+126%) . Thus since 1998 average DDD-costs remained stable (slight decrease: -8.5%). Conclusions:
Inflation-adjusted direct costs for HAART regimens remain stable since the introduction of HAART, although more complex and cost intensive treatment options became available. This could be explained by (a) increasing use of NNRTIs as compared to the begin of the HAART-era, (b) moderate pricing of (new) antiretroviral drugs, (c) by health-policy measures, e.g. the 16% discount by law for drugs in Germany in 2004, and (d) the economically conscientious prescription of ARVs by the specialised physicians. Recent recommendations to start HAART earlier in HIV infection might increase drug costs in the future. [RKI_SÖDAK]
* ClinSurv has been founded temporarily within the German CompNet HIV/AIDS by the German BMBF.