Appropriateness Score and Cost Evaluation In Hiv: The Aprosce System, on Field Clinical Evaluation

Description

Methods All patients followed by our HIV outpatients service who started a first or an early switch regimen in 2014 have been enrolled. Demographic and epidemiological data were recorded. Each HIV treatment receives a score resulting from combining its relevance (according to Italian guidelines) and its related monthly cost. The most appropriate and less expensive regimen got a score of 1 point, whilst other are rated declining progressively by 0,05 points according to their value based on the two parameters described above (range: 1-0,1). Furthermore, we followed the clinical course recording CD4 cell increase and HIV viral load decrease as a surrogate marker of quality of life. Results 42 pts. included (29 male); mean age : 42 years. 26 patients were in first line, 13 on early switch. Average treatment duration was 198 days (16-362). Mean CD4 was 270 cc/ml for 1st line patients and 462 for early switch respectively. 11 Only 9 patients were classified C according to CDC criteria (A=11; B=26). we obtained an overall appropriateness score of 0,89, tenofovir-Based Single Tablet Regimens (TVD-STR) rated 0,99 , PI-Based Regimens got a score of 0,91. Mean monthly therapy cost was € 627,3 vs. € 719,8 respectively. After three months, all patients were virologically suppressed. Conclusions Our study helped in defining the APROSCE system as an efficacious tool to evaluate the correlation of treatment appropriateness, drug expense and clinical outcomes .Higher score is a predictor of better outcomes and less drug expenditure. Related savings might be invested in more complex patients management with multi drug resistant strains or AIDS presenter.

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