A 10-year economic analysis of HIV management in Greece: evidence of efficient resource allocation.

OBJECTIVE: Human Immunodeficiency Virus (HIV) prevalence has substantially increased over the years, leading to increased direct medical costs. The aim of the present study was to assess the long-term cost of HIV care in Greece incurred over the last decade. METHODS: In order to assess the long-term cost of HIV care, a cost analysis was undertaken for three discrete time points (which reflect major changes in the HIV treatment paradigm), incorporating the evolution of the cost of pharmaceuticals, hospitalization, primary care visits and diagnostic tests. The cost per life year gained (LYG) was also estimated. RESULTS: Total cost of HIV care increased by 57% over the last decade (€53.7 million in 2010 vs €84.5 million in 2019), which can be mainly attributed to a 107% (5084 in 2010 vs. 10,523 in 2019) increase observed in the number of people living with HIV (PLWH) under care. As a result, the cost per person on treatment has decreased by 24.0% (€10,567 in 2010 vs €8032 in 2019). Lifetime cost was lower and life expectancy higher in 2019 compared to 2010, leading to a - €711 cost per LYG, suggesting that the current treatment paradigm produces better health outcomes at a lower cost compared to a decade ago, implying that resources are used in a more efficient way. CONCLUSION: The paper presents some evidence towards the direction that HIV management in Greece can be considered efficient in both clinical and financial terms, as it offers measurable clinical outcomes at well-controlled, almost inelastic spending.

Cost estimation of patients admitted to the intensive care unit: a case study of the Teaching University Hospital of Thessaly.

OBJECTIVE: This study aimed to estimate the cost of patients admitted to the Intensive Care Unit (ICU) of the Teaching University Hospital of Thessaly (TUHT) in 2006 and to demonstrate discrepancies between actual hospitalisation cost and social funds' reimbursement. METHODS: Cost analysis was performed using a macro-costing approach, which focused on the estimation of nominal and actual cost per ICU patient. Data were derived from the annual records of resources consumed in each hospital unit and from hospital balance sheets. Sensitivity analysis was also performed by inflating nominal costs to present values. RESULTS: There were 312 patients admitted to the ICU. Mean actual cost per ICU patient was estimated at €16,516, whereas actual reimbursement from social funds was only €1,671. This means that reimbursement accounted for just 10% of the actual hospitalisation cost. Once nominal costs were inflated to present values, the reimbursement accounted for 25% of the actual hospitalisation cost. The major cost drivers of ICU hospitalisation were personnel costs followed by infrastructure, hotel services and pharmaceutical expenditure. These results may be limited by a lack of consideration for clinical outcomes along with a high level of aggregation in cost data. CONCLUSION: Reimbursement should be re-adjusted in order to balance public hospital deficits and make public-private mix viable. This way, intensive care capacity would increase and allow a more equitable distribution of healthcare resources.

Analysis of published economic evaluations of angiotensin receptor blockers.

INTRODUCTION: In this study we reviewed the published literature on the economic evaluation of the use of angiotensin receptor blockers (ARBs) for the treatment of hypertension, either primary or due to diabetes. METHODS: An extensive literature review was undertaken. The HEED (Health Economic Evaluations Database) of the Office for Health Economics and the NHS-EED (NHS Economic Evaluation Database) databases were searched. Keywords used were "losartan", "irbesartan", "valsartan", "candesartan", "olmesartan", "telmisartan", "eprosartan", "primary hypertension" and "diabetes". The study included all articles retrieved from 2001 onwards. Exclusion criteria included economic evaluations of ARBs for other indications (e.g. heart failure, myocardial infarction, etc.), an underage population, as well as prevalence studies of hypertension for a disease-specific population. RESULTS: Of the 63 studies retrieved in the literature search, 35 were included in the review. The majority of the studies were of irbesartan (16) or losartan (8). In each study, the model used country-specific data to project and evaluate the clinical and cost outcomes of the treatment arms. The most common method undertaken was cost-consequence analysis (52.94%) followed by cost-effectiveness analysis (32.35%). In most cases, costs and benefits results were not synthesised. Results failed to show a clear advantage in favour of specific therapy, as the outcomes suffered from heterogeneity, referred to specific circumstances and were rather difficult to compare. For different treatment comparators, all the analyses demonstrated an improved life expectancy and a cost-saving choice. The robustness of results was tested with a series of sensitivity analyses, which showed a statistically significant result in each case. CONCLUSIONS: The evidence from this review suggests that the available ARBs represent a cost-saving and cost-effective treatment compared with other conventional treatment options for patients with hypertension and associated conditions. However, there are no meaningful differences between available ARBs, as the design of clinical and economic studies makes it difficult to find any such differences.