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

Authored by Timothy B Hallett, Mikaela Smit, Rachel Cassidy, Alessandro Cozzi-Lepri, Eugenia Quiros-Roldan, Enrico Girardi, Alessia Mammone, Andrea Antinori, Annalisa Saracino, Francesca Bai, Stefano Rusconi, Giacomo Magnani, Francesco Castelli, Priscilla Hsue, Antonella d'Arminio Monforte

Date Published: 2017

DOI: 10.1371/journal.pone.0186638

Sponsors: No sponsors listed

Platforms: No platforms listed

Model Documentation: Other Narrative Flow charts

Model Code URLs: Model code not found

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 Naive 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.

Tags

Infection population cascade