Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands.
<h4>Introduction</h4>In Europe, half of people living with HIV (PLWH) present late to care, with associated higher morbidity and mortality. This study aims to assess short- and long-term costs of HIV-care based on time of presentation and identify other factors contributing to higher cos...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0280877 |
| _version_ | 1797850456849907712 |
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| author | Stephanie Popping Lisbeth Versteegh Brooke E Nichols David A M C van de Vijver Ard van Sighem Peter Reiss Suzanne Geerlings Charles A B Boucher Annelies Verbon ATHENA observational cohort |
| author_facet | Stephanie Popping Lisbeth Versteegh Brooke E Nichols David A M C van de Vijver Ard van Sighem Peter Reiss Suzanne Geerlings Charles A B Boucher Annelies Verbon ATHENA observational cohort |
| author_sort | Stephanie Popping |
| collection | DOAJ |
| description | <h4>Introduction</h4>In Europe, half of people living with HIV (PLWH) present late to care, with associated higher morbidity and mortality. This study aims to assess short- and long-term costs of HIV-care based on time of presentation and identify other factors contributing to higher costs in the first and fifth year after antiretroviral therapy (ART) initiation.<h4>Material and methods</h4>We included ATHENA cohort data which prospectively includes 98% of PLWH in the Netherlands. PLWH who initiated ART in 2013 were included and followed over five years. PLWH were divided in three categories based on CD4 cell-count at time of ART initiation: timely presentation (CD4>350cells/μL), late presentation (CD4 200-350cells/μL or >350cells/μL with AIDS-defining illness) and very late presentation (CD4<200cells/μL). The total HIV-care cost was calculated distinguishing ART medication and non-ART medication costs (hospitalization, outpatient clinic visits, co-medications, and HIV-laboratory tests).<h4>Results</h4>From 1,296 PLWH, 273 (21%) presented late and 179 (14%) very late. Nearly half of those who entered HIV-care in a very late stage were of non-Dutch origin, with 21% originating from sub-Saharan Africa. The mean cost per patient in the first year was €12,902 (SD€11,098), of which about two-thirds due to ART (€8,250 (SD€3,142)). ART costs in the first and fifth year were comparable regardless of time of presentation. During the first year on treatment, non-ART medication costs were substantially higher among those with late presentation (€4,749 (SD€8,009)) and very late presentation (€15,886 (SD€ 21,834)), compared with timely presentation (€2,407(SD€4,511)). Higher non-ART costs were attributable to hospitalization and co-medication. The total non-ART costs incurred across five years on treatment were 56% and 246% higher for late and very late presentation respectively as compared to timely presentation.<h4>Conclusion</h4>Very late presentation is associated with substantial costs, with non-ART costs nearly seven times higher than for those presenting timely. Hospitalization and co-medication costs are likely to continue to drive higher costs for individuals with late presentation into the future. Programs that identify individuals earlier will therefore likely provide significant short- and long-term health cost savings. |
| first_indexed | 2024-04-09T19:00:34Z |
| format | Article |
| id | doaj.art-b84c356bd1de4c30b8f97c77f68ced30 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-09T19:00:34Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-b84c356bd1de4c30b8f97c77f68ced302023-04-08T05:32:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01182e028087710.1371/journal.pone.0280877Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands.Stephanie PoppingLisbeth VersteeghBrooke E NicholsDavid A M C van de VijverArd van SighemPeter ReissSuzanne GeerlingsCharles A B BoucherAnnelies VerbonATHENA observational cohort<h4>Introduction</h4>In Europe, half of people living with HIV (PLWH) present late to care, with associated higher morbidity and mortality. This study aims to assess short- and long-term costs of HIV-care based on time of presentation and identify other factors contributing to higher costs in the first and fifth year after antiretroviral therapy (ART) initiation.<h4>Material and methods</h4>We included ATHENA cohort data which prospectively includes 98% of PLWH in the Netherlands. PLWH who initiated ART in 2013 were included and followed over five years. PLWH were divided in three categories based on CD4 cell-count at time of ART initiation: timely presentation (CD4>350cells/μL), late presentation (CD4 200-350cells/μL or >350cells/μL with AIDS-defining illness) and very late presentation (CD4<200cells/μL). The total HIV-care cost was calculated distinguishing ART medication and non-ART medication costs (hospitalization, outpatient clinic visits, co-medications, and HIV-laboratory tests).<h4>Results</h4>From 1,296 PLWH, 273 (21%) presented late and 179 (14%) very late. Nearly half of those who entered HIV-care in a very late stage were of non-Dutch origin, with 21% originating from sub-Saharan Africa. The mean cost per patient in the first year was €12,902 (SD€11,098), of which about two-thirds due to ART (€8,250 (SD€3,142)). ART costs in the first and fifth year were comparable regardless of time of presentation. During the first year on treatment, non-ART medication costs were substantially higher among those with late presentation (€4,749 (SD€8,009)) and very late presentation (€15,886 (SD€ 21,834)), compared with timely presentation (€2,407(SD€4,511)). Higher non-ART costs were attributable to hospitalization and co-medication. The total non-ART costs incurred across five years on treatment were 56% and 246% higher for late and very late presentation respectively as compared to timely presentation.<h4>Conclusion</h4>Very late presentation is associated with substantial costs, with non-ART costs nearly seven times higher than for those presenting timely. Hospitalization and co-medication costs are likely to continue to drive higher costs for individuals with late presentation into the future. Programs that identify individuals earlier will therefore likely provide significant short- and long-term health cost savings.https://doi.org/10.1371/journal.pone.0280877 |
| spellingShingle | Stephanie Popping Lisbeth Versteegh Brooke E Nichols David A M C van de Vijver Ard van Sighem Peter Reiss Suzanne Geerlings Charles A B Boucher Annelies Verbon ATHENA observational cohort Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands. PLoS ONE |
| title | Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands. |
| title_full | Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands. |
| title_fullStr | Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands. |
| title_full_unstemmed | Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands. |
| title_short | Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands. |
| title_sort | characteristics and short and long term direct medical costs among adults with timely and delayed presentation for hiv care in the netherlands |
| url | https://doi.org/10.1371/journal.pone.0280877 |
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