Economic impact of the highly active antiretroviral pharmacotherapy on cost and HIV/AIDS control in Bulgaria

Abstract

The objective of this study was to analyze the changes in the antiretroviral pharmacotherapy during the period 2006-2011 and its impact on the cost and disease control of HIV/AIDS in Bulgaria. The cost and therapeutic results of HIV/AIDS patient's therapy were analyzed in a combined retrospective and prospective observational real life study. The patients were treated in the main University Clinic for immunosuppressed patients in Sofia - the University Hospital for Active Treatment of Infectious and Parasitic Diseases "Prof. Ivan Kirov". Approximately 2/3 of the HIV/AIDS patients in Bulgaria were treated in the Clinic in 2006-2011. Information was gathered about the way in which the disease was transmitted, antiretroviral combinations therapy and their cost, CD4 count, and viral load per patient per year. The changes in the dosage regimes, cost of therapy and its influence on CD4 count and viral load were evaluated. Descriptive statistic Willcoxon tests and Spearman correlation analysis were applied. In total 162 patients' records were studied and 48 patients with changes in therapy were identified. Nearly 40 different dosage regimes were identified and all of them are combinations of 3 or 4 medicines. During the period three new antiretroviral medicines (tenofovir, emtricitabine, darunavir) were introduced. The average yearly cost of pharmacotherapy (all regimes and patients) was found to increase from 155 837.64 euro to 319 571.76 euro in 2006-2010 due to switch of the therapy for some of the patients to newer medicines because of drug toxicity, resistance or other reasons. To all treatment-naive patients the newly authorized medicines were prescribed which led to sustained suppression of vial load to <20 in 45.46 % of the patients. Introduction of the new medicines led to a 291 89.64 euro increase in the total pharmacotherapy cost, but also to better control measured with the increase in the CD4 count and suppression of viral load. In conclusion, HIV/AIDS remain costly diseases for the Bulgarian population but new medicines lead to better control of its progress and thus could save further hospital costs.