Valutazione delle conseguenze epidemiologiche ed economiche generate dal ritardo di trattamento dei pazienti HIV-positivi causato dalla pandemia COVID-19

Abstract

Objective:: To assess, from an epidemiological and economic point of view, the consequences of the reduction in the supply of antiretroviral drugs due to the COVID-19 pandemic.

Method:: The analysis was conducted by adapting a Markov model previously published in literature. The simulations were conducted considering the possibility of continuous treatment for patients already diagnosed (no therapeutic interruptions are expected) and an immediate start of patients with new diagnosis during 2021. This analysis was compared with a scenario involving a therapeutic interruption or diagnostic delay caused by COVID-19.

Results:: The analysis showed that the scenario characterized by a treatment delay, compared to the scenario of early resumption of therapy, could generate an increase in the number of patients with CD4 < 200 equal to 1,719 subjects (+16%) and a reduction in the number of patients with CD4 500 equal to 6,751 (−9%). A timely resumption of treatment for HIV+ patients could prevent 296, 454 and 687 deaths in the third, fifth and tenth years of analysis respectively with a potential cost reduction equal to 78,9 million at a 10 year time horizon.

Conclusions:: These findings show that it is essential, especially in a pandemic situation such as the present one, to introduce technological, digital and organizational solutions, aimed at promoting timely diagnosis and at accelerating the therapeutic switch for patients who are no longer targeted.

Fig. 1 -

Struttura del modello.

Fig. 2 -

Decessi evitati e incremento cumulato dei QALYs per anno di analisi grazie a una ripresa tempestiva del trattamento. A: Decessi evitati (valori cumulati). B: Incremento cumulato dei QALYs.

Fig. 3 -

Risparmi in termini di costi diretti associati alla gestione della malattia e in termini di costi indiretti, ottenibili grazie a una ripresa tempestiva del trattamento.

Figura A:

Variazione del numero di pazienti per livello di CD4 scenario ritardo di trattamento vs caso-base a 3, 5 e 10 anni