Direct treatment costs of HIV/AIDS in Portugal / Custos diretos com tratamento do VIH/SIDA em Portugal / Costos originados por tratamiento del VIH/SIDA en Portugal

OBJECTIVE To analyze the direct medical costs of HIV/AIDS in Portugal from the perspective of the National Health Service. METHODS A retrospective analysis of medical records was conducted for 150 patients from five specialized centers in Portugal in 2008. Data on utilization of medical resources during 12 months and patients’ characteristics were collected. A unit cost was applied to each care component using official sources and accounting data from National Health Service hospitals. RESULTS The average cost of treatment was 14,277 €/patient/year. The main cost-driver was antiretroviral treatment (€ 9,598), followed by hospitalization costs (€ 1,323). Treatment costs increased with the severity of disease from € 11,901 (> 500 CD4 cells/µl) to € 23,351 (CD4 count ≤ 50 cells/ µl). Cost progression was mainly due to the increase in hospitalization costs, while antiretroviral treatment costs remained stable over disease stages. CONCLUSIONS The high burden related to antiretroviral treatment is counterbalanced by relatively low hospitalization costs, which, however, increase with severity of disease. The relatively modest progression of total costs highlights that alternative public health strategies that do not affect transmission of disease may only have a limited impact on expenditure, since treatment costs are largely dominated by constant antiretroviral treatment costs. .

OBJETIVO Analizar los costos médicos originados por tratamiento de VIH/SIDA, de acuerdo con la perspectiva del Servicio Nacional de Salud, en Portugal. MÉTODOS Se realizó análisis retrospectivo de registros médicos en muestra de 150 pacientes de cinco centros especializados, en 2008. Se obtuvieron datos de utilización de recursos médicos y de las características de los pacientes, en horizonte temporal de 12 meses. Se aplicó el costo unitario a cada componente de costo, usando fuentes oficiales y datos de contabilidad de los hospitales. RESULTADOS El costo promedio anual del tratamiento fue de 14,277€ por paciente. La parcela de costo más importante fue el relacionado con el tratamiento antiretrovial (9,598€), seguido por los costos de internación (1,323€). Los costos de tratamiento con severidad aumentaron de 11,901€ (> 500 CD4 células/µl) para 23,351€ (CD4 ≤ 50 células/µl). La progresión de los costos se debe mayormente al aumento de los costos de internación, dado que los costos por tratamiento antiretrovial se mantienen constantes a lo largo de las fases. CONCLUSIONES El elevado costo del tratamiento antiretrovial es compensado por el costo relativamente bajo de la internación, a pesar de que éste aumenta con la severidad. La baja progresión de los costos totales revela que estrategias de salud pública alternativas que no alteren la transmisión de la enfermedad tendrán sólo impacto limitado en los gastos, dado que los costos son mayormente influenciados por el tratamiento antiretrovial. .

OBJETIVO Analisar dos custos diretos médicos com VIH/SIDA, de acordo com a perspetiva do Serviço Nacional de Saúde, em Portugal. MÉTODOS Efetuou-se análise retrospectiva de registros médicos em amostra de 150 pacientes de cinco centros especializados em 2008. Foram obtidos dados de utilização de recursos médicos durante 12 meses e das características dos pacientes nesse período. Aplicou-se o custo unitário a cada componente de custo, usando fontes oficiais e dados contabilísticos dos hospitais. RESULTADOS O custo médio anual de tratamento foi de 14.277 euros por paciente. A parcela de custo mais importante foi o custo com o tratamento antirretroviral (9.598 euros), seguido dos custos de internação (1.323 euros). Os custos de tratamento com severidade aumentaram de 11.901 euros (> 500 CD4 células/µl) para 23.351 euros (CD4 ≤ 50 células/µl). A progressão dos custos deve-se principalmente ao aumento dos custos de internação, dado que os custos com tratamento antirretroviral se mantêm constantes ao longo dos estádios. CONCLUSÕES O custo elevado do tratamento antirretroviral é compensado com o custo relativamente baixo da internação, apesar deste aumentar com a severidade. A baixa progressão dos custos totais revela que estratégias de saúde pública alternativas que não alterem a transmissão da doença terão apenas impacto limitado nas despesas, dado que os custos são largamente influenciados pelo do tratamento antirretroviral. .

Tuberculosis with Malaria or HIV Co-Infection in a Large Hospital in Luanda; Angola

"Introduction: Three major public health problems; tuberculosis; malaria and HIV/AIDS; are widespread in Angola; often as co-infections in the same individual. In 2009; it was assumed that 44;151 new cases of TB occurred in Angola. Interestingly; interventions such as treatment/prevention of malaria appear to reduce mortality in HIV-infected and possibly TB co-infected patients. However; despite the seriousness of the situation; current data on TB and co-infection rates are scarce. This study aimed to characterize all TB cases seen at the Hospital Sanatorio de Luanda; and to determine the co-infection rate with HIV and/or malaria. Methodology: This retrospective study collected demographic; diagnostic and clinical data from all patients admitted during 2007. Results: A total of 4;666 patients were admitted; of whom 1;906 (40.8) were diagnosed with TB. Overall; 1;111 patients (58.3) were male and most patients (n=1302; 68.3) were adults (""d14 years). The rate of HIV co-infection was 37.4 (n=712). Malaria was diagnosed during admission and hospital stay in 714 patients (37.5); with Plasmodium falciparum the predominant species. Overall mortality was 15.2(n=290). Conclusions: Because Luanda does not have the infrastructure to perform culture-based diagnosis of TB; confirmation of TB is problematic. The HIV-co-infection rate is high; with 37.4 of patients requiring integrated approaches to address this problem. With more than 1/3 of the TB patients co-infected with malaria; even during the hospital stay; the prevention of malaria in TB patients appears to be an effective way to reduce overall mortality."