Discrepancy of HIV-realated treatment cost of HIV patients before and after receiving GPO-VIR in Saraburi province

Abstract

Although the triple antiretroviral combination can delay the HIV progression and reduce mortality rate among HIV patients, its cost is relatively high. In Thailand, GPO-VIR, the triple ARV combination drug, costs only US$ 1 per day. It is important to know if the drug cost could compensate other HIV-related treatment costs. The purpose of this study was to determine whether the reduction of opportunistic infection treatment cost among HIV patients by GPO-VIR offsets their increased cost after providing GPO-VIR. Cost-consequences analysis was employed based upon the societal perspective. Clinical and cost data of the HIV patients before and after receiving GPO-VIR were collected. Only the HIV patients who had CD4 cell count less than 200 cell/cb.mm. at the initiation of receiving GPO-VIR treatment were recruited in the study. Of the 78 HIV patients, 52.6% were females and 80.8% had the CD4 cell count level less than 100 cell/cb.mm. at the initial treatment. The treatment costs before receiving GPO-VIR were 4,346.2 baht per patient per year (PPPY). After receiving GPO-VIR, the total costs were 22,682.1 baht PPPY including 18,369.2 baht PPPY for the GPO-VIR cost and 4,313.0 baht PPPY for the treatment cost. The hospitalization cost reduced from 1,978.3 baht PPPY to 815.5 baht PPPY after receiving GPO-VIR. The reduction of hospital cost due to the increase of CD4 level and the decrease of severe OI. The mean of the CD4 cell count level (179.2 +- 94.0) after receiving GPO-VIR significantly increased from baseline (56.5 +- 52.9) at the initial treatment (P = 0.000). After receiving the GPO-VIR, 87.2% of the patient remains using the initial regimen. The incidence rate of specific OI at OPD visit substantially decreased including pneumocystis carinii pneumonia (PCP), cytomegolovirus (CMV), tuberculosis (TB), cryptococcal meningitis, and oral cadidiasis. After receiving GPO-VIR, none of the HIV patients was admitted to the hospital due to PCP and cryptococcal meningistis. Nevertheless, four HIV patients (5.1%) were admitted with severe ADR including two cases of acidosis, one case of renal failure, and one case of hepatic failure. Treatment of ADR cost from GPO-VIR could be considered as high proportion of hospitalization cost (48.4%). After receiving GPO-VIR, although the overall cost did not outweigh the cost prior to the ARV treatment, it substantially decreased severe OI and hospitalization cost. The positive impact of GPO-VIR will encourage HIV patients to demand for ARV drug and consequently enhance provider to increase universal coverage of GPO-VIR for all eligible HIV patients in Thailand.