Chia-Te Liao1,2, Chun-Ting Yang3, Pin-Hao Chen3, Han Siong Toh4,5, Shihchen Kuo6,7, Zhih-Cherng Chen1, Huang-Tz Ou3,8,9, Nai-Ying Ko10, Jung-Der Wang2. 1. Division of Cardiology, Department of Internal Medicine, Chimei Medical Center, USA. 2. Department of Public Health, College of Medicine, National Cheng Kung University, USA. 3. Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, USA. 4. Department of Intensive Care Medicine, Chimei Medical Center, USA. 5. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, USA. 6. Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, USA. 7. Michigan Center for Diabetes Translational Research, University of Michigan, Ann Arbor, USA. 8. Department of Pharmacy, College of Medicine, National Cheng Kung University, USA. 9. Department of Pharmacy, National Cheng Kung University Hospital, USA. 10. Department of Nursing, College of Medicine, National Cheng Kung University, USA.
Abstract
AIMS: There is a lack of studies that rigorously and systematically assess the economic burden of cardiovascular diseases (CVDs) related to the use of antiretroviral therapy (ART). We aimed to assess the association between adherence to ART and economic burden of CVDs in an HIV-infected population. METHODS: Taiwan's National Health Insurance Research Database 2000-2011 was utilized for analyzing 18,071 HIV-infected patients free of CVDs before HIV diagnosis. The level of adherence to ART was measured by the medication possession ratio (MPR). Generalized estimating equations analysis was applied to estimate the cost impact of a variety of CVDs. All costs were presented in 2018 US dollars. RESULTS: The incidence of CVDs ranged from 0.17/1000 person-years (cardiogenic shock) to 2.60/1000 person-years (ischemic heart diseases (IHDs)). The mean annual medical cost for a base-case patient without CVDs was US$3000. Having cerebrovascular diseases, myocardial infarction, heart failure, arrhythmia, and IHDs increased annual costs by 41%, 33%, 30%, 16%, and 14%, respectively. The cost impact of incident CVDs in years with high adherence to ART (MPR ≥ 0.8) was significantly lower than that in years with low adherence (MPR < 0.1) (e.g. having cerebrovascular diseases in the high- versus low-adherence years increased annual costs by 21% versus 259%, respectively). CONCLUSION: The economic burden of incident CVDs in an HIV-infected population was compelling and varied by the extent of using ART. A reduced economic impact of CVDs was found in years when patients possessed a greater adherence to ART. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: There is a lack of studies that rigorously and systematically assess the economic burden of cardiovascular diseases (CVDs) related to the use of antiretroviral therapy (ART). We aimed to assess the association between adherence to ART and economic burden of CVDs in an HIV-infected population. METHODS: Taiwan's National Health Insurance Research Database 2000-2011 was utilized for analyzing 18,071 HIV-infected patients free of CVDs before HIV diagnosis. The level of adherence to ART was measured by the medication possession ratio (MPR). Generalized estimating equations analysis was applied to estimate the cost impact of a variety of CVDs. All costs were presented in 2018 US dollars. RESULTS: The incidence of CVDs ranged from 0.17/1000 person-years (cardiogenic shock) to 2.60/1000 person-years (ischemic heart diseases (IHDs)). The mean annual medical cost for a base-case patient without CVDs was US$3000. Having cerebrovascular diseases, myocardial infarction, heart failure, arrhythmia, and IHDs increased annual costs by 41%, 33%, 30%, 16%, and 14%, respectively. The cost impact of incident CVDs in years with high adherence to ART (MPR ≥ 0.8) was significantly lower than that in years with low adherence (MPR < 0.1) (e.g. having cerebrovascular diseases in the high- versus low-adherence years increased annual costs by 21% versus 259%, respectively). CONCLUSION: The economic burden of incident CVDs in an HIV-infected population was compelling and varied by the extent of using ART. A reduced economic impact of CVDs was found in years when patients possessed a greater adherence to ART. Published on behalf of the European Society of Cardiology. All rights reserved.