Resumen

Objectives: Spain has a highly decentralized administration, which could lead to important HIV related healthcare costs variability. In the context of a cost-effectiveness analysis of HIV testing strategies, we collected epidemiologic, healthcare utilization and cost data of HIV+ patients from 2007-2011. The objective of the present analysis was to assess cost variability of different antiretroviral treatment (ART) regimens in different hospitals of Spain in 2011. Methods: Ten hospitals of the Spanish AIDS Research Network Cohort, from seven different autonomous communities, participated in this study. Single-dose cost including local taxes for all ART drugs were collected from Hospital Pharmacies. Bed number and referral population were taken from Hospital Reports. Total cost by combination/month (30 days intake) was calculated for preferred ART regimens for initial therapy defined by 2010 Spanish AIDS Study Group guidelines. We calculated mean, standard deviation, minimum and maximum costs per combination. Comparison between TDF/FTC/EFV and TDF/FTC+EFV was done through Student´s t-test. Differences by number of beds and referral population were calculated through one-way ANOVA. Results: ABC/3TC+EFV had the lowest mean cost at 574.98€/month, and the highest was TDF/FTC+RAL at 1001.84€/month. The cheapest cost combination identified was TDF/FTC+NVP at 474.3€/month, and the costliest was TDF/FTC+RAL at 1156.08€/month. ABC/3TC+RAL had the greatest variability in costs with a standard deviation of 118.72€, and a difference between mínimum and maximum cost paid of 364.87€/month. No difference was found between TDF/FTC/EFV or TDF/FTC+EFV (p=0.8304). No differences in costs were found based on the number of beds; but 5 combinations mean cost seemed to decrease with increasing hospital bed number. No differences were found by referral population. Conclusion: High variability in ART costs accounting for almost 4380€/year/patient is related to differences in raltegravir costs between hospitals, while variability between ART regimens of around 5122€/year/patient is mainly due to differences between raltegravir and efavirenz costs. (Extraído del documento)