HIV/AIDS treatment in Brazil: impact of adherence on resource utilization and costs

Abstract

Objective: To determine the impact of adherence to antiretroviral treatment on resource utilization and costs in the management of HIV/AIDS patients in Brazil. Methods: A systematic review was conducted in December 2019. Eligibility criteria considered Brazilian adults with HIV/AIDS, presenting data on treatment adherence, resource utilization, and treatment-associated costs. Results: The search retrieved 964 references and three were eligible for inclusion. Total cost was estimated at 227,362.00 BRL in six months (N = 100 – direct and indirect costs) and 579,264.80 BRL per year (N = 157 – direct costs) in individuals adhering to the treatment. In 40 non-adherent patients, estimated total cost, considering only direct costs, was 136,023.25 BRL per year. When estimates were standardized by the analysis period and sample size, non-adherent patients demonstrate a lower total cost when compared to those adhering to the treatment [170,029.06 BRL (direct costs) versus 184,479.24 BRL (direct costs) and 227,362.00 BRL (direct and indirect costs)]. However, the group of patients who did not adhere to the treatment showed a higher cost, with a statistically significant difference, for consultations and the need for hospitalization. Incremental cost-effectiveness ratio for adherent (7,622 BRL per clinical response) was smaller when compared to non-adherent group (9,716 BRL per clinical response). Conclusions: Despite the scarcity of studies evaluating the relationship between adherence to treatment and costs with the management of HIV/AIDS in Brazil, data found corroborates the hypothesis that non-adherence to treatment may be associated with higher costs.