BACKGROUND: Country-specific forecasts of the growing non-communicable disease (NCD) burden in ageing HIV-positive patients will be key to guide future HIV policies. We provided the first national forecasts for Italy and the Unites States of America (USA) and quantified direct cost of caring for these increasingly complex patients. METHODS AND SETTING: We adapted an individual-based model of ageing HIV-positive patients to Italy and the USA, which followed patients on HIV-treatment as they aged and developed NCDs (chronic kidney disease, diabetes, dyslipidaemia, hypertension, non-AIDS malignancies, myocardial infarctions and strokes). The models were parameterised using data on 7,469 HIV-positive patients from the Italian Cohort Naïve to Antiretrovirals Foundation Study and 3,748 commercially-insured patients in the USA and extrapolated to national level using national surveillance data. RESULTS: The model predicted that mean age of HIV-positive patients will increase from 46 to 59 in Italy and from 49 to 58 in the USA in 2015-2035. The proportion of patients in Italy and the USA diagnosed with ≥1 NCD is estimated to increase from 64% and 71% in 2015 to 89% and 89% by 2035, respectively, driven by moderate cardiovascular disease (CVD) (hypertension and dyslipidaemia), diabetes and malignancies in both countries. NCD treatment costs as a proportion of total direct HIV costs will increase from 11% to 23% in Italy and from 40% to 56% in the USA in 2015-2035. CONCLUSIONS: HIV patient profile in Italy and the USA is shifting to older patients diagnosed with multiple co-morbidity. This will increase NCD treatment costs and require multi-disciplinary patient management.

Projections of non-communicable disease and health care costs among HIV-positive persons in Italy and the U.S.A. : a modelling study / S. Mikaela, C. Rachel, C. Alessandro, Q. Eugenia, G. Enrico, M. Alessia, A. Andrea, S. Annalisa, F. Bai, S. Rusconi, M. Giacomo, C. Francesco, H. Priscilla, A. D'Arminio Monforte, H. Timothy B.. - In: PLOS ONE. - ISSN 1932-6203. - 12:10(2017 Oct 23), pp. e0186638.1-e0186638.12. [10.1371/journal.pone.0186638]

Projections of non-communicable disease and health care costs among HIV-positive persons in Italy and the U.S.A. : a modelling study

F. Bai;S. Rusconi;A. D'Arminio Monforte;
2017-10-23

Abstract

BACKGROUND: Country-specific forecasts of the growing non-communicable disease (NCD) burden in ageing HIV-positive patients will be key to guide future HIV policies. We provided the first national forecasts for Italy and the Unites States of America (USA) and quantified direct cost of caring for these increasingly complex patients. METHODS AND SETTING: We adapted an individual-based model of ageing HIV-positive patients to Italy and the USA, which followed patients on HIV-treatment as they aged and developed NCDs (chronic kidney disease, diabetes, dyslipidaemia, hypertension, non-AIDS malignancies, myocardial infarctions and strokes). The models were parameterised using data on 7,469 HIV-positive patients from the Italian Cohort Naïve to Antiretrovirals Foundation Study and 3,748 commercially-insured patients in the USA and extrapolated to national level using national surveillance data. RESULTS: The model predicted that mean age of HIV-positive patients will increase from 46 to 59 in Italy and from 49 to 58 in the USA in 2015-2035. The proportion of patients in Italy and the USA diagnosed with ≥1 NCD is estimated to increase from 64% and 71% in 2015 to 89% and 89% by 2035, respectively, driven by moderate cardiovascular disease (CVD) (hypertension and dyslipidaemia), diabetes and malignancies in both countries. NCD treatment costs as a proportion of total direct HIV costs will increase from 11% to 23% in Italy and from 40% to 56% in the USA in 2015-2035. CONCLUSIONS: HIV patient profile in Italy and the USA is shifting to older patients diagnosed with multiple co-morbidity. This will increase NCD treatment costs and require multi-disciplinary patient management.
Adult; Female; HIV Infections; Humans; Italy; Male; United States; Health Care Costs; Models, Theoretical; Biochemistry, Genetics and Molecular Biology (all); Agricultural and Biological Sciences (all)
Settore MED/17 - Malattie Infettive
Article (author)
File in questo prodotto:
File Dimensione Formato  
M Smit et al., Italy vs USA, PLoS ONE Oct. 23, 2017.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 1.07 MB
Formato Adobe PDF
1.07 MB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/533702
Citazioni
  • ???jsp.display-item.citation.pmc??? 19
  • Scopus 39
  • ???jsp.display-item.citation.isi??? 39
social impact