Beneficio clínico y económico de 32 años de tratamiento antirretroviral de personas que viven con VIH en España: ¿ha sido una intervención eficiente?

Abstract

Introduction: Although antiretroviral therapy (ART) for HIV / AIDS was introduced in 1987, improvementin disease progression and reduction in mortality at a population level was not observed until 1996, withthe combination of three or more drugs. The objective was to estimate the clinical and economic benefitof ART in Spain in the 32-year period between 1987 and 2018. Methods: A cost-benefit analysis was performed, using a second-order Monte Carlo simulation, from the societal (base case) and the National Health System (NHS) perspectives. New cases of HIV, AIDS and related deaths were obtained from the SINIVIH and UNAIDS registries, with population projections without ART using triple exponential smoothing. Expenditure on ART was obtained from the National AIDS Plan reports and market studies. Results: The NHS invested 6,185 million euros in 32 years. In that period, 323,651 AIDS-related deaths, 500,129 AIDS cases and 161,417 HIV cases were averted, with total savings of 41,997 million euros. The net benefit (net savings) is estimated at 35,812 million euros (societal) and 1,032 million euros (NHS). For every euro invested in ART, a return on investment of (sic) 6.79 and (sic) 1.16 was obtained, respectively. Conclusion: The use of ART over 32 years prevented a large number of deaths and cases of AIDS and HIV, providing significant economic savings for the NHS. ART is an efficient intervention for the NHS. (c) 2021 The Author(s). Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica.