Changing cost of English HIV service provision 1996-1997

the objectives of this study were to provide individual and population-base d unit cost estimates of HIV treatment and care by stage of HIV infection f or adults in England and estimate the financial impact of the use of combin ation antiretroviral therapy. Individual unit cost estimates were calculate d, based on 1997 activity data, and linked to the number of diagnosed HIV-i nfected individuals using statutory medical services by clinical stage of H IV infection in England during 1997 to obtain population-based cost estimat es; these were compared with 1996 estimates. Most clinical guidelines now r ecommend the use of 3 antiretroviral agents, but cost estimates for mono an d dual therapy were included as baseline estimates. Baseline costs for trea ting AIDS patients with zidovudine (AZT) monotherapy were estimated at poun d 16,830 (95% CI 14,633-18,985) per patient-year which was substantially lo wer than the 1996 estimate; costs for asymptomatic individuals and people w ith symptomatic non-AIDS were pound 4450 (95% CI 3521-5612) and pound 7289 (95% CI 6169-8386) per respective patient-year which did not differ substan tially from 1996. The total annual population cost estimate for HIV service provision amounted to pound 128 million (95% CI pound 109m to pound 147m), if all patients with HIV disease were treated with AZT monotherapy only. F or all eligible patients to be treated with 2 nucleoside reverse transcript ase inhibitors (NRTI) (AZT and didanosine (ddI) or zalcitabine (ddC)), cost estimates amounted to pound 161m (95% CI pound 141m to pound 181m), while for triple therapy, annual estimated expenditure amounted to pound 185m (95 % CI pound 165m to pound 206m) when a non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine) was included or pound 205m (95% CI pound 186 m to pound 235m) when a protease inhibitor was included. Compared with 1996 population-based cost estimates, the estimates for monotherapy decreased b y 14%, by 11% for dual therapy, by 10% for triple therapy which included a NNRTI and by 9% if a protease inhibitor was used as part of a triple therap y regimen. Similarly, compared with 1996 estimates, the proportion of total costs attributable to treating asymptomatic individuals increased by 5% an d 2-3% for people with symptomatic non-AIDS, while the proportion attributa ble for treating people with AIDS decreased by 8-9%.