The societal burden of HIV/AIDS in Northern Italy: An analysis of costs and quality of life

Abstract

This study aims to measure the direct and indirect costs of HIV/AIDS care and quality of life (QoL) of HIV-infected patients in Northern Italy. We conducted a prospective cohort study over 12 months, enrolling a sample of 121 patients with HIV infection from two cities in Northern Italy. Patients were surveyed at baseline and were followed-up at 6 and 12 months. To assess the relationship between costs and stage of disease, patients were categorized into three groups at baseline: “No HAART” (asymptomatic and never before on highly active antiretroviral therapy (HAART)), “Stable HAART” (HAART with mild HIV infection and no prior opportunistic infections) and “HAART failure” (primary HAART regimen was altered because of severe side effects or immunological failure). Direct medical costs were based on utilization of (day) hospital admissions, diagnostic procedures, laboratory tests, clinic visits, consultations and antiretroviral drug use. Indirect costs included production losses due to absence from work, reduced productivity at work and reduced unpaid labour participation. QoL was assessed by visual analogue scale. Parametric regression was used to estimate the expected value and the standard deviation of annual costs per patient. The expected value of total annual costs was €1818 and €9820 and €12,332, for groups “No HAART”, “Stable HAART” and “HAART failure” respectively. We estimated annual expected earnings as €14,994 and €10,811 and €9820 for the same respective groups. The expected value of QoL on a scale of 0–1 in these same patient groups was 0.80, 0.78 and 0.64. We conclude that indirect costs contribute substantially to total costs and are comparable in magnitude to the direct costs excluding antiretroviral drugs. The costs of inpatient care in our cohort were almost negligible compared to total costs. Despite being in treatment, many patients were still gainfully employed and generated substantial expected annual earnings.

Keywords:

• HIV AIDS care
• direct costs
• indirect costs
• quality of life
• Italy

Acknowledgements

The authors gratefully acknowledge funding by Sanofi Pasteur. We are grateful to Leona van Roijen (Erasmus University Rotterdam, The Netherlands) and colleagues for permission to use the SF-HLQ instrument. We thank Paul Y. Peng (Queen's University, Kingston, Canada) for his statistical advice and for sharing his GFCURE software package for the generalized F distribution in the public domain. We also thank the patients who generously volunteered their time to enrol in the study.