Trends in costs for HIV care during the HCV early treatment and elimination program: A data linkage study of claims and Swiss HIV Cohort Study data
In a study recently published in Open Forum Infectious Diseases, Aghlmandi et al investigated the impact of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) on health care costs in Switzerland. Using an anonymous data linkage approach to link SHCS data and claims data for antiretroviral therapy (ART) from two large Swiss health insurers, the authors aimed to study cost drivers for HIV care between 2012 and 2017 with a specific interest in the effect of the then novel and highly effective DAAs against HCV. They used date of birth, sex and type of first ART to match the SHCS population to claims data, and calculated annual costs in Swiss francs, adjusted for censoring (lost to follow-up or entry into SHCS during a given year). They then fitted a linear mixed model to investigate changes in costs in relation to patient characteristics, HIV-related factors and comorbidities.
Overall, the study was able to include 1830 linked SHCS participants for cost analysis. During the observation period from 2012 to 2017, mean annual overall costs per participant increased from CHF 24’713 to 24’881 (+1.2%), whereas median overall costs decreased from CHF 23’411 to 21’594 (-7.8%). Costs for ART contributed by far the most to overall costs (2012: mean CHF 20’708; 2017: mean CHF 16’426). Several characteristics were identified as being associated higher overall costs including older age, lower level of education, injection drug use, lower CD4 cell counts and history of virologic failure. Of the 171 individuals with chronic HCV, 82 received at least one treatment with DAAs during the study period and HCV treatment increased cost by a mean of CHF 52’647 for overall costs.
In summary, the authors showed that despite high costs per individual, the costs of DAAs in Switzerland only had a marginal impact on overall health care costs. In combination with a previous report from the SHCS showing a decrease in the incidence of HCV and liver-related deaths following an HCV treatment and elimination program in MSM (Weber MSR et al., Clin Infect Dis 2024), it is likely that the future costs for complications saved outweigh the costs spent for DAAs also in Switzerland.