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Analysis of drug costs in a domiciliary care unit for AIDS patients: a 3-year survey
International Journal of Antimicrobial Agents 16 (2000) 363 – 364 www.ischemo.org
Analysis of drug costs in a domiciliary care unit for AIDS patients: a 3-year survey A. Beltrame a,b,*, D. Gori b, F. Marenco b, D. Bassetti a, F. Henriquet b a
Department of Infectious Diseases and Tropical Medicine, Uni6ersity of Genoa, Ospedale S. Martino, Largo R. Benzi, 10 Genoa, Italy b Gigi Ghirotti Association, Genoa, Italy
Keywords: Pharmacoeconomics; Drug costs; Domiciliary care
Highly active antiretroviral therapy (HAART) has resulted in dramatic reductions in infection-related morbidity and mortality of HIV positive individuals [1,2], but there are still a number of chronically or terminally ill persons who require intensive domiciliary care. The aim of this study is to evaluate the drug cost for domiciliary care, except for antiretroviral therapy, and to assess its variations, if any, after the introduction of HAART [3,4]. At present, most HIV patients need care for disseminated mycobacterial disease, oesophageal candidiasis and cytomegalovirus retinitis as well as rehabilitation therapy and psychiatric and psychological care. All patients have many problems with poly pharmacy The Gigi Ghirotti Association started its activity in 1984 with cancer patients and is a body dedicated to the domiciliary care of terminally ill patients. In 1994 by arrangement with the National Health Service, it also started taking care of AIDS patients. The specialist team for the domiciliary care of AIDS patients consists of an infectious diseases physician, other specialists, a
nurse, a psychologist, a social worker, a physiotherapist, an occupational therapist and volunteers. The collaboration between the physician and the nurse is of great importance. The nurse is the team member who spends the longest time with the patient and his family and therefore has a better knowledge of the patient. This should result in better support of the patient and the ability to verify his compliance with the therapy [5]. We analyzed the annual drug costs of the Gigi Ghivotti Association (except antiretroviral therapy) and the number of days of domiciliary care during the period 1996–1998. The total domiciliary drug cost did not show a significant variation during the period analyzed although there was a big reduction in the use of antivirals such as gancyclovir, antifungals such as amphotericin B or fluconazole and antibiotics for antimycobacterial therapy which cost more than other antiinfective drugs (Table 1Fig. 1). AIDS patients required an increase of psychiatric therapy after the introduction of protease inhibitors.
Table 1 Total drug costs 1996–1998 Year
Drug cost in Italian lira
No. of patients
Days of domiciliary care Drug costs for each day of domiciliary care (Italian lira)
1996 1997 1998
257 448 909 301 998 304 293 858 636
57 54 55
7581 9233 9480
34 000 32 700 31 000
* Corresponding author. Tel.: +39-010-5552668; fax: +39-010-5556712. E-mail address: [email protected] (A. Beltrame). 0924-8579/00/$ - $20 © 2000 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved. PII: S 0 9 2 4 - 8 5 7 9 ( 0 0 ) 0 0 2 6 7 - 3
364
A. Beltrame et al. / International Journal of Antimicrobial Agents 16 (2000) 363–364
Fig. 1. Anti-infective drug cost.
References [1] Kirk O, Mocroft A, Katzenstein TL, et al. Changes in use of antiretroviral therapy in regions of Europe over time. AIDS 1998;12:2031 – 9. [2] Mocroft A, Vella S, Benfielt TL, et al. Changing patterns of mortality across Europe in patients infected with HIV-1. Lancet 1998;352:1725– 30.
.
[3] Beltrame A, Gori D, Borrazzo A, et al., Variazioni nel consumo dei farmaci dal 1996 al 1998 in un ente di assistenza domiciliare per pazienti HIV+ a Genova. XII Congresso ANLAIDS, Genova, 25 – 28 November, 1998. [4] Bassetti D, Del Bono V, Di Biagio A, Bassetti M, Farmacoeconomia nel trattamento dell’infezione da HIV, 1997. [5] Doyle D, Hanks GWC, MacDonald N. Oxford Textbook of Palliative Medicine. Second edition
Analysis of drug costs in a domiciliary care unit for AIDS patients: a 3-year survey A. Beltrame a,b,*, D. Gori b, F. Marenco b, D. Bassetti a, F. Henriquet b a
Department of Infectious Diseases and Tropical Medicine, Uni6ersity of Genoa, Ospedale S. Martino, Largo R. Benzi, 10 Genoa, Italy b Gigi Ghirotti Association, Genoa, Italy
Keywords: Pharmacoeconomics; Drug costs; Domiciliary care
Highly active antiretroviral therapy (HAART) has resulted in dramatic reductions in infection-related morbidity and mortality of HIV positive individuals [1,2], but there are still a number of chronically or terminally ill persons who require intensive domiciliary care. The aim of this study is to evaluate the drug cost for domiciliary care, except for antiretroviral therapy, and to assess its variations, if any, after the introduction of HAART [3,4]. At present, most HIV patients need care for disseminated mycobacterial disease, oesophageal candidiasis and cytomegalovirus retinitis as well as rehabilitation therapy and psychiatric and psychological care. All patients have many problems with poly pharmacy The Gigi Ghirotti Association started its activity in 1984 with cancer patients and is a body dedicated to the domiciliary care of terminally ill patients. In 1994 by arrangement with the National Health Service, it also started taking care of AIDS patients. The specialist team for the domiciliary care of AIDS patients consists of an infectious diseases physician, other specialists, a
nurse, a psychologist, a social worker, a physiotherapist, an occupational therapist and volunteers. The collaboration between the physician and the nurse is of great importance. The nurse is the team member who spends the longest time with the patient and his family and therefore has a better knowledge of the patient. This should result in better support of the patient and the ability to verify his compliance with the therapy [5]. We analyzed the annual drug costs of the Gigi Ghivotti Association (except antiretroviral therapy) and the number of days of domiciliary care during the period 1996–1998. The total domiciliary drug cost did not show a significant variation during the period analyzed although there was a big reduction in the use of antivirals such as gancyclovir, antifungals such as amphotericin B or fluconazole and antibiotics for antimycobacterial therapy which cost more than other antiinfective drugs (Table 1Fig. 1). AIDS patients required an increase of psychiatric therapy after the introduction of protease inhibitors.
Table 1 Total drug costs 1996–1998 Year
Drug cost in Italian lira
No. of patients
Days of domiciliary care Drug costs for each day of domiciliary care (Italian lira)
1996 1997 1998
257 448 909 301 998 304 293 858 636
57 54 55
7581 9233 9480
34 000 32 700 31 000
* Corresponding author. Tel.: +39-010-5552668; fax: +39-010-5556712. E-mail address: [email protected] (A. Beltrame). 0924-8579/00/$ - $20 © 2000 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved. PII: S 0 9 2 4 - 8 5 7 9 ( 0 0 ) 0 0 2 6 7 - 3
364
A. Beltrame et al. / International Journal of Antimicrobial Agents 16 (2000) 363–364
Fig. 1. Anti-infective drug cost.
References [1] Kirk O, Mocroft A, Katzenstein TL, et al. Changes in use of antiretroviral therapy in regions of Europe over time. AIDS 1998;12:2031 – 9. [2] Mocroft A, Vella S, Benfielt TL, et al. Changing patterns of mortality across Europe in patients infected with HIV-1. Lancet 1998;352:1725– 30.
.
[3] Beltrame A, Gori D, Borrazzo A, et al., Variazioni nel consumo dei farmaci dal 1996 al 1998 in un ente di assistenza domiciliare per pazienti HIV+ a Genova. XII Congresso ANLAIDS, Genova, 25 – 28 November, 1998. [4] Bassetti D, Del Bono V, Di Biagio A, Bassetti M, Farmacoeconomia nel trattamento dell’infezione da HIV, 1997. [5] Doyle D, Hanks GWC, MacDonald N. Oxford Textbook of Palliative Medicine. Second edition