Productivity costs and determinants of productivity in HIV-infected patients

doi:10.1016/S0149-2918(04)90080-X

Clinical Therapeutics

Volume 26, Issue 5, May 2004, Pages 791-800

https://doi.org/10.1016/S0149-2918(04)90080-X Get rights and content

Abstract

Background: In HIV-infected patients, reduced ability to work may be an important component of the societal costs of this disease. Few data about productivity costs in HIV-infected patients are available.

Objective: The goals of this study were to estimate productivity costs in the HIV-infected population in Switzerland and to identify characteristics that may influence patient productivity.

Methods: This cross-sectional study included all patients younger than retirement age (65 years for men and 62 years for women) who were enrolled in the Swiss HIV Cohort Study in 2002. Measures of productivity losses in this population were based on patients' ability to work and the median monthly wage rates adjusted for age, sex, and educational level in Switzerland. Factors associated with ability to work were analyzed in a multivariate ordinary logistic regression (proportional odds) model. As of July 1, 2002, the exchange rate for US dollars to Swiss francs (CHF) was US $1.00 ≈ CHF 1.48.

Results: A total of 5319 HIV-infected patients (3665 men [68.9%] and 1655 women [31.1%]; mean [SD] age, 40.6 [8.4] years; range, 17–64 years) were included in the study. The mean annual productivity loss per patient was estimated at CHF 22,910 (95% CI, CHF 22,064-CHF 23, 756). Ability to work was independently associated with the following (P < 0.001 for all): age (10-year increase: odds ratio [OR], 0.60 [95% CI, 0.54–0.62]), sex (female/male: OR, 0.73 [95% CI, 0.63–0.84]), history of IV drug use (OR, 0.22 [95% CI, 0.19–0.26]), time since first positive HIV test (>10 years vs ⩽10 years: OR, 0.66 [95% CI, 0.58–0.76]), CD4 cell count (201–500 vs 0–200 cells/μL: OR, 1.68 [95% CI, 1.38–2.46]; ⩾501 vs 0–200 cells/μL: OR, 2.01 [95%, CI, 1.64–2.46]), history of AIDS-indicator disease (OR, 0.47 [95% CI, 0.41–0.55]), stable partnership during the last 6 months (OR, 1.63 [95% CI, 1.43–1.86]), and educational level (higher vs basic: OR, 1.68 [95% CI, 1.45–1.95]).

Conclusions: Productivity losses to society for the HIV-infected population appeared to be substantial in this analysis. Given a patient's clinical health status, a higher education level and a stable partnership were associated with greater ability to work. Socioeconomic characteristics may influence the cost-effectiveness of health care interventions in HIV-infected patients.

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Citation Excerpt :
As far as we know, no research is available regarding these indirect costs of PLWH with depressive symptoms. Though, it has been found that the reported annual indirect costs for PLWH, irrespective of depressive symptoms, range from €1353 per person in 2010 in Italy [7], to €19,786 per person in 2002 in Switzerland [8]. For people with depression, irrespective of HIV, the annual indirect costs have been investigated in 2010 in 30 European countries and were found to be €1782 on average per person [9].
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This economic evaluation was conducted alongside a randomized controlled trial. The control group received attention only and was put on a waiting list. Quality adjusted life years were calculated over six months. The study was conducted from a societal perspective and included intervention costs, healthcare costs, and non-healthcare costs. Participants completed a pretest, a post-test after two to three months, and a second post-test after six months. Cost-utility acceptability curves were constructed and two sensitivity analyses were conducted.
No differences between the intervention and the control group were found in quality adjusted life years and total societal costs. The results indicate that the intervention is likely to be cost-effective, compared to attention only. The findings of the sensitivity analyses point in the same direction.
More research with larger samples is necessary to confirm the findings. The outcomes of this study may inform policy makers to decide which interventions will be included in policies. The guided Internet intervention may improve psychological care for people living with HIV and depressive symptoms, against low costs.
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Original researchProductivity costs and determinants of productivity in HIV-infected patients

Abstract

Lancet

Soc Sci Med

Clin Ther

J Health Econ

Expenditures for the care of HIV-infected patients in the era of highly active antiretroviral therapy

N Engl J Med.

Lifetime cost of HIV care in France during the era of highly active antiretroviral therapy

Antiviral Ther.

The changing direct costs of medical care for patients with HIV/AIDS, 1995–2001

CMAJ

Long-term impact of highly active antiretroviral therapy on HIV-related health care costs

J Acquired Immune Defic Syndr.

The HAART side of resource allocation