Economic burden of HIV disease from 2012 to 2017 based on the French national claim database (SNDS)

• Published in: European journal of public health Vol. 29; no. Supplement_4
• Main Authors: Pestel, L P, Constantinou, P C, Nicolas, M N, Rivière, S R, Rachas, A R, Gastaldi-Ménager, C G M
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2019; Oxford Publishing Limited (England)
• Subjects: Algorithms; Ambulatory care; Ambulatory medical care; Annual variations; Drug prices; Economic analysis; Emergency medical services; Expenditures; Growth rate; Health care industry; Health insurance; HIV; Human immunodeficiency virus; Insurance; Mathematical analysis; Medical treatment; Patients; Payments; Prices; Public health; Trends
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckz187.150

Abstract Background The aim of this study was to assess the economic burden of HIV disease in France, by analyzing structure and trends of expenditure between 2012 and 2017. Methods We identified people with HIV disease among beneficiaries of the health insurance general scheme (covering more than 57 million people, 87% of the French population), applying algorithms combining inpatient and outpatient diagnoses and claims for specific drug treatments or laboratory examinations. The individuals’ expenditure (26 different items) reimbursed for hospitalizations, ambulatory care and cash payments were included. A top-down method was used to attribute expenditure to HIV disease based on the average expenditure calculated for individuals with only HIV disease. To analyze trends, we applied the same methodology from 2012 through 2017. Results In 2017, HIV disease was identified for 131 800 individuals (0.2% of the population) and expenditure attributed to HIV disease corresponded to €1.3 billion (1% of the 140.1 billion reimbursed by the general insurance scheme). Drug treatment accounted for 85% of total expenditure reimbursed (1.2 billion). Between 2012 and 2017, the number of HIV patients identified increased steadily (+16,800 patients with an annual growth rate of 2.8%) and expenditure attributed to HIV disease increased by €8 billion. However, annual expenditure growth was variable, as a result of instability in the average annual cost per patient, ranging from 9,700€to 11,100€per year per patient. This reflects changes in practice and drug prices. Conclusions The detailed analysis of expenditures attributed to HIV disease showed that drug treatments account for the large majority of total reimbursements. Annual variation in total expenditure could therefore reflect evolution in prescription practices, such as the extension of treatment indications; or in drug prices, with the availability of combined treatments. Key messages Drug treatments account for the large majority of total reimbursements among HIV patients. Variation in total expenditure attributed to HIV disease is mainly driven by prescription practices and drug prices.