Higher ARV Compliance Leads to Health Bill Savings of US$85 per Patient, Reveals Johns Hopkins

Lower Healthcare Costs Through Greater ARV Adherence

Higher adherence to anti-retroviral (ARV) therapies not only improves the progression and survival of HIV, but is also associated with overall lower healthcare costs. This is the result of a study conducted by the Johns Hopkins Bloomberg School of Public Health (U.S.). The study was conducted in Cape Town, South Africa, and involved 6,833 HIV-positive adults who were enroled in Aid for AIDS, a private-sector disease-management programme, between 2000 and 2006. The results revealed that greater adherence led to a median monthly healthcare cost saving of US$85 per patient.

The additional costs resulting from lower adherence were largely on account of higher hospital use. According to Jean B. Nachega, the lead author of the study, hospitalisation costs increased from 29% to 51% of the total ARV disease management programme costs where there were lower adherence rates.

The above results are featured in the 5 January 2010 issue of the Annals of Internal Medicine, with the key results available to view here.

Outlook and Implications

The study's results offer a major incentive to governments to ensure that access and adherence to ARV regimens are increased, and call for budget increases to enable the same. Another highlight of the study is that increased access to newer ARVs has been shown to produce better disease-progression rates and thus reduce hospitalisation owing to associated illness. These conclusions make the study an important one for developing and emerging nations alike.

While the importance of preventing incidence and improving quality of life for the HIV population is increasing world over, several critics are of the opinion that not enough is being done. Even in developed economies like the United Kingdom, which offers ARVs as part of its universal health cover, physicians at HIV and sexual health clinics report rationing of ARVs owing to insufficient priority being given to the condition at local levels (source: Disturbing Symptoms 5, published by the Terrence Higgins Trust, AIDSMAP). The situation only becomes worse in countries like South Africa, where the Free State has stopped enrolling new patients onto the national ARV programme. Furthermore, as with any other developing nation, the country also faces the issue of having a fragmented health system, where calls for increased ARV-adherence budgets could prove difficult given that hospital budgets are divorced from outpatient HIV treatment budgets. Nachega suggests an effective and practical method to monitor adherence and correlate this to hospitalisation, in order to make evident the savings possible.