Projections of non-communicable disease and health care costs among HIV-positive persons in Italy and the U.S.A.: A modelling study

Abstract

Background: Country-specific forecasts of the growing non-communicable disease (NCD) burden in ageing HIV-positive patients will be key to guide future HIV policies. We provided the first national forecasts for Italy and the Unites States of America (USA) and quantified direct cost of caring for these increasingly complex patients.

Methods and setting: We adapted an individual-based model of ageing HIV-positive patients to Italy and the USA, which followed patients on HIV-treatment as they aged and developed NCDs (chronic kidney disease, diabetes, dyslipidaemia, hypertension, non-AIDS malignancies, myocardial infarctions and strokes). The models were parameterised using data on 7,469 HIV-positive patients from the Italian Cohort Naïve to Antiretrovirals Foundation Study and 3,748 commercially-insured patients in the USA and extrapolated to national level using national surveillance data.

Results: The model predicted that mean age of HIV-positive patients will increase from 46 to 59 in Italy and from 49 to 58 in the USA in 2015-2035. The proportion of patients in Italy and the USA diagnosed with ≥1 NCD is estimated to increase from 64% and 71% in 2015 to 89% and 89% by 2035, respectively, driven by moderate cardiovascular disease (CVD) (hypertension and dyslipidaemia), diabetes and malignancies in both countries. NCD treatment costs as a proportion of total direct HIV costs will increase from 11% to 23% in Italy and from 40% to 56% in the USA in 2015-2035.

Conclusions: HIV patient profile in Italy and the USA is shifting to older patients diagnosed with multiple co-morbidity. This will increase NCD treatment costs and require multi-disciplinary patient management.

Fig 1. Basic schematic of the model design.

The model follows patients on antiretroviral therapy from 2010 to 2035 or death. The model simulates how patients age over time and develop clinical events, including non-communicable diseases or death. The model takes into account key interactions between demographic factors (blue), e.g. how age and gender can impact risk of death, and clinical factors (green) e.g how hypertension can increase the risk of chronic kidney disease or death. Adapted from source: Smit et al [9]. Abbreviations: Myocardial Infarction (MI), Chronic Kidney Disease (CKD).

Fig 2

The age distribution of HIV-positive patients on antiretroviral therapy in A. Italy and B. the USA between 2015 and 2035.

Fig 3. The predicted change in non-communicable disease burden.

A. The number of HIV-positive patients on antiretroviral therapy with 0,1, 2 or 3 and more non-communicable diseases between 2015 and 2035 in Italy and USA. Note: the two graphs are not on the same axis. B. The predicted co-morbidities profiles amongst HIV-positive patients on antiretroviral therapy in 2035 based on a cross-section of 100 patients (each square represents one patient) for Italy and the USA. Abbreviations: Cardiovascular disease (CVD), Chronic kidney disease (CKD), Moderate CVD (dyslipidemia and/or hypertension) and Severe CVD (MI or stroke); United States of America (USA).

Fig 4

Percentage contribution of HIV and NCD treatment costs to overall costs of care of HIV-positive patients on antiretroviral therapy in 2015 and 2035 in A. Italy and B. the USA. Abbreviations: Chronic kidney disease (CKD), Myocardial infraction (MI).