Direct costs for the treatment of HIV-infection in a German cohort after the introduction of HAART

Background: Highly active antiretroviral combination therapy (HAART) has become the standard of care for HIV infection. The reduction of morbidity by HAART has been proven to be cost-effective despite high expenditures for regular use of antiretrovirals. We examined direct costs in a German monocentric cohort of HIV-infected patients after introduction of HAART. Subjects/Methods: In 1997 recruitment started and 201 patients gave informed consent. They underwent structurized interviews. Additional data were taken from the patient's records. Later on follow-ups were performed for the same cohort in the years 2000 and 2001 respectively. Direct costs have been calculated per patient and year for each period. Results: The proportion of HAART treated patients rised in the cohort from 86% to 93%. The mean of antiretrovirals used per case increased from 2.4 to 3.4. Nevertheless mean direct costs for HAART decreased significantly from Euro 17,746 to Euro 16,007. Reduction of expenditures for additional drugs, hospitalisation and diagnostics led to about one third decrease of mean total direct cost from Euro 35,865 in 1997 to Euro 24,482 in 2001. For surviving patients expenditures remained higher in advanced stage of disease for HAART, hospitalisation, diagnostics and total costs. Conclusion: Expenditures for HAART remained on a high level. Despite rising drug prices and increased use of antiretrovirals a decrease of mean costs of HAART by about 10% resulted from more frequent use of less expensive drug combinations. The continuous decrease of expenditures for non-HAART dry, diagnostics and hospitalisation predominated and therefore HAART caused about a half of total direct costs in 1997 and two third in 2001 respectively. Higher expenditures in advanced stages of disease continued over the follow up perlod and raise the question of an economic impact of earlier initiation of treatment. More extensive use of standardized evaluation of direct costs could be an important tool towards a more rational allocation of resources in health care.