The Cost of HIV Disease in Northern Italy: The Payer's Perspective

Background: Healthcare expenditures incurred by the Health Service for HIV-infected patients have not been reported in Italy. Objective: To present health care costs for HIV-infected patients in the Lombardy Region, in 2004-2007, to determine the clinical characteristics of HIV infection associated with costs. Methods: Retrospective, observational, budget impact study, based on information collected for the period 2004-2007, including hospitalizations, outpatient services, highly active antiretroviral therapy (HAART) and non-HAART drug utilization. Inclusion criteria includes: confirmed HIV infection, age >= 18 years, resident in Lombardy Region, and followed at the L. Sacco Hospital in Milan from 2004 to 2007. Results: The mean total cost per year to provide healthcare to HIV-positive patients was rather stable ((sic)9658.36 in 2004 and (sic)9745.65 in 2007 (+0.90%)); HAART represented more than 60% of the total cost. We found that hepatitis C virus coinfection was related to higher costs ((sic)11,003.45 vs. (sic)8896.06), as well as CD4 cell count <200 cells/mm(3) ((sic)12,681.36 vs. (sic)9594.11 and (sic)9450.36 in 200-499 and >= 500 cells/mm(3), respectively). The mean total cost of HIV health care was higher in patients who initiated antiretroviral treatment before 1997 than in those who started after 1996. Conclusions: The mean total cost per year to provide health care to HIV-positive patients was stable during the period 2004-2007, with an increase of HAART percentage impact on the total cost. Several clinical characteristics of HIV-infected patients were significantly associated with cost variation.