Annals Study: Promoting ART Adherence Saves Money

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When the World Health Organization called for earlier initiation of antiretroviral therapy, there was considerable hand-wringing among health economists about the increased costs associated with millions of additional HIV patients who would be newly eligible for HIV drugs under the revised treatment guidelines.

But a new study in the Annals of Internal Medicine suggests, among other things, that earlier and wider access to ART could be cost effective for a country’s overall health care system. That’s because the earlier a patient starts HIV therapy, the less likely he or she is to need hospitalization for opportunistic infections or other health needs.

The article, written by Jean B. Nachega, MD, and co-authors and based on a study of South African HIV/AIDS patients, finds that stronger adherence to antiretroviral drugs is associated with decreases in total monthly health care costs. The authors estimate that improving adherence lowers the mean total cost of medical care by $85 a month.

“They provide compelling data indicating that increasing resources to enhancing HIV-infected patients’ antiretroviral adherence is associated with substantial cost savings for the entire public health system,” notes an accompanying commentary piece in the Annals. Their findings may even underestimate “the full benefit of improved adherence, because these calculations did not include the societal benefits of restoring health and economic productivity.”

In the main article, the authors write: “Most of the effect of adherence on reducing total health care costs is explained by significantly lower hospitalization costs for patients with higher ART adherence. If ART costs continue to decrease (for example, because of increased availability of generic ART), then the relative contribution of ART costs to total costs will also decrease, which will lead to further program cost savings for patients with higher adherence.”

These findings have significant policy implications, starting with the idea that better patient monitoring and adherence promotion is a smart and efficient use of resources. It could improve outcomes for HIV-infected patients and decrease drug resistance (thereby avoiding the need to move to more expensive second-line regimens), as well as lead to broader cost savings across health systems.

“The obvious next step is to determine how best to allocate resources to promote adherence and realize these benefits,” David R Bangsberg, MD, MPH, writes in the related commentary. “Nachega and colleagues tell us that it makes sense to invest in improving adherence even when resources are scarce.”

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