Study On The Cost, Effect And Effect Of Different Antiviral Therapy Strategies In AIDS Single Family

Background:Since 2003, in responsing to the government policy called "Four Frees One Care", the work of antiretroviral treatment (ART) was actively promoted around the whole country, with the coverage of ART expanded gradually. With the gradual improvement of eligible criteria of free ART, the quality of life, the effectiveness of ART, and cost effectiveness/utility analysis of different ART strategy for HIV/AIDS patients from HIV serodiscordant couples have not been reported in domestic related research.Objective:By understanding HIV/AIDS patients’ quality of life, the implementation of ART and the influence factors among HIV serodiscordant couples in survey area, the quality of life and effectiveness of ART have been evaluated. The cost, cost-effectiveness analysis and cost-utility analysis were studied in different ART strategy for HIV/AIDS patients from HIV serodiscordant couples in survey area, in order to providing the basis and scientific evidence of treatment as prevention through expanding ART strategy for the decision-making departments to adjust and implement ART measures according to local conditions in the next step.Methods:The research method was divided into two parts. The first part was on the basis of field investigation. HIV/AIDS patients from HIV serodiscordant couples were the objects in Zhoukou city of Henan province. A series of effectiveness indicators and the general characteristics of HIV/AIDS patients, for example quality of life, the direct medical costs and indirect medical costs, the cases of conversion HIV positive in HIV serodiscordant coupples, the cumulative life year, the ratio of viral load inhibition and the proportion of CD4 cell growth, was collected to carry out cost-effectiveness analysis in different ART strategy through conducting the questionnaire survey from Jan to May in 2015 and analysing the case reporting database of HIV/AIDS Comprehensive Response Information Management System in survey area. The second part was for the Markov model construction and the Markov model simulation calculation. The quality adjusted life years were obtain and cost-utility analysis was developed between the early and conventional ART strategy in HIV/AIDS patients from HIV serodiscordant couples in survey area.Results:The total cost of 2,271 HIV/AIDS patients among HIV serodiscordant couples receiving ART was calculated with 308.3291 million yuan from 2004～2015 in survey area according to the measuring per capita annual cost of all kinds of direct medical costs and indirect medical cost combined with local CPI rise and fall ratio in every year. The total costs at different CD4 cell level starting ART were CD4 count≤200 cells/mm3 with 121.7787 million yuan, CD4 count in 201～350 cells/mm3 with 104.7085 million yuan, CD4 count in 351-500 with 46.8031 million yuan, CD4 count>500 cells/mm3 with 35.0388 million yuan respectively. The per capita annual cost of four groups was 21,300 yuan,24,200 yuan,21,400 yuan and 19,600 yuan respectively. Among them, the per capita annual cost of CD4 count>500 cell/mm3 was minimum. Through the analysis of variance, except the second-line drugs cost in four groups, there is statistical significant difference in other categories of antiretroviral treatment costs (p<0.01).The results of cost-effectiveness analysis in different ART strategy carried on the HIV/AIDS patients among HIV serodiscordant couples in investigation area pointed to that the lowest cost-effectiveness ratio was 21,300 yuan per life year in CD4 count≤200 cells/mm3 comparing with the second lowest cost-effectiveness ratio 22,000 yuan per life year in CD4 count>500 cells/mm3. And ICER of ART strategy with CD4 count>500 cells/mm3 was minimum with spending 22,500 yuan to get one more life year. Putting the proportion of avoiding conversion of HIV positive in HIV serodiscordant spouses as the effectiveness indicator, the lowest cost-effectiveness ratio was 1.2234 million yuan per protection one proportion of HIV serodiscordance in CD4 count≤200 cells/mm3 ART strategy comparing with the maximum cost-effectiveness ratio 3.0954 million yuan per avoiding one proportion HIV serodiscordance in CD4 count>500 cells/mm3 ART strategy. However, ICER of CD4 count>500 cells/mm3 ART stategy was minimum with spending less 33,300 yuan to protecting one proportion of HIV serodiscordance. Getting the inhibition rate of VL as effectiveness indication the inhibition rate of VL was unstable in different ART strategy. In CD4 count≤200 cells/mm3 ART strategy, cost-effectiveness ratio was minimum with the results of every year CD4 testing. And the cost-effectiveness ratio of CD4 count>500 cells/mm3 ART stategy was the second minimum comparing with the ART strategy of CD4 count≤200 cells/mm3.And the cost-effectiveness ratio of CD4 count>500 cells/mm3 ART stategy was lower than other strageties besides of the ART strategy of CD4 count≤200 cells/mm3 in first, second and sixth year after receiving ART. The same as the ratio of CD4 per year growth in different ART strategy, the cost-effectiveness ratio was minimum in CD4 count≤200 cells/mm3 ART strategy. However, the cost-effectiveness ratio was maximum in CD4 count>500 cells/mm ART strategy in first year with the ART strategy of CD4 count≤500 cells/mm3 maximum in other year. Comparing with the ART strategy of CD4 count≤200 cells/mm3, the ICER was minimum in ART strategy of CD4 count≤350 cells/mm3.The results of study of QOL in survey area showed that the scores of zhoukou city in the physical, psychological, social relations, and environmental domain were (12.00±2.02), (12.07±2.07), (11.87±1.99) and (11.09±1.84), respectively. Compared with the scores of domestic general population in four domains(15.10±2.30)、(13.89±1.89)、(13.93±2.06) and (12.14±2.08), there was statistically significant difference in every domain(P<0.001). However the scores of QOL in physiological, psychological, social relation, and environmental domains in Taizhou city of Zhejiang province were (14.99±2.25), (14.25±2.12), (13.22±2.37), and (13.31±1.99) respectively. Except the score of environmental domain (P< 0.05), the scores in other domains had no significant difference with the results of the national norm level. What’s more, the scores of four domain in HIV serodiscordant spouse in Taizhou were (14.76±2.43), (14.07±2.16), (13.07±2.24) and(13.07±1.97), higher than the scores in Zhoukou city with significant difference in every domain(P< 0.01).The results of cost-utility analysis showed that each QALY gained will cost 29,600 yuan in deferred ART strategy (CD4 count≤350 cells/mm3), and 31,800 yuan in early ART strategy (CD4 count>350 cells/mm3). Compared to the deferred ART strategy, the result of incremental cost-utility ratio (ICUR) was 64,800 yuan per QALY gained in the early ART strategy, namely acquiring one more QALY needs to spend more 64,800 yuan in survey area. The results of cost-utility analysis were conformed to the WHO principle of cost benefit.Conclusion:In survey area, the early ART strategy was implementated for HIV/AIDS patients among HIV serodiscordant couples, not only expanding the coverage of ART services, prolonging the life of HIV/AIDS patients, but also reducing the proportion of conversion HIV positive in HIV serodiscordant spouses. The results of cost-effectiveness analysis were significant and conformed to the WHO principle of cost effectiveness.