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

Mikaela Smit, Rachel Cassidy, Alessandro Cozzi-Lepri, Eugenia Quiros-Roldan, Enrico Girardi, Alessia Mammone, Andrea Antinori, Annalisa Saracino, Francesca Bai, Stefano Rusconi, Giacomo Magnani, Francesco Castelli, Priscilla Hsue, Antonellad Arminio Monforte, Timothy B. Hallett

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Article numbere0186638
JournalPLoS One
Volume12
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

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health care costs
noninfectious diseases
Health care
Health Care Costs
Italy
HIV
Costs
Medical problems
Aging of materials
Cost of Illness
hyperlipidemia
Dyslipidemias
hypertension
diabetes
Hypertension
Costs and Cost Analysis
burden of disease
myocardial infarction
kidney diseases
Chronic Renal Insufficiency

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Projections of non-communicable disease and health care costs among HIV-positive persons in Italy and the U.S.A. A modelling study. / Smit, Mikaela; Cassidy, Rachel; Cozzi-Lepri, Alessandro; Quiros-Roldan, Eugenia; Girardi, Enrico; Mammone, Alessia; Antinori, Andrea; Saracino, Annalisa; Bai, Francesca; Rusconi, Stefano; Magnani, Giacomo; Castelli, Francesco; Hsue, Priscilla; Monforte, Antonellad Arminio; Hallett, Timothy B.

In: PLoS One, Vol. 12, No. 10, e0186638, 01.10.2017.

Research output: Contribution to journalArticle

Smit, M, Cassidy, R, Cozzi-Lepri, A, Quiros-Roldan, E, Girardi, E, Mammone, A, Antinori, A, Saracino, A, Bai, F, Rusconi, S, Magnani, G, Castelli, F, Hsue, P, Monforte, AA & Hallett, TB 2017, 'Projections of non-communicable disease and health care costs among HIV-positive persons in Italy and the U.S.A. A modelling study', PLoS One, vol. 12, no. 10, e0186638. https://doi.org/10.1371/journal.pone.0186638
Smit, Mikaela ; Cassidy, Rachel ; Cozzi-Lepri, Alessandro ; Quiros-Roldan, Eugenia ; Girardi, Enrico ; Mammone, Alessia ; Antinori, Andrea ; Saracino, Annalisa ; Bai, Francesca ; Rusconi, Stefano ; Magnani, Giacomo ; Castelli, Francesco ; Hsue, Priscilla ; Monforte, Antonellad Arminio ; Hallett, Timothy B. / Projections of non-communicable disease and health care costs among HIV-positive persons in Italy and the U.S.A. A modelling study. In: PLoS One. 2017 ; Vol. 12, No. 10.
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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 Na{\"i}ve 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.",
author = "Mikaela Smit and Rachel Cassidy and Alessandro Cozzi-Lepri and Eugenia Quiros-Roldan and Enrico Girardi and Alessia Mammone and Andrea Antinori and Annalisa Saracino and Francesca Bai and Stefano Rusconi and Giacomo Magnani and Francesco Castelli and Priscilla Hsue and Monforte, {Antonellad Arminio} and Hallett, {Timothy B.}",
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T2 - A modelling study

AU - Smit, Mikaela

AU - Cassidy, Rachel

AU - Cozzi-Lepri, Alessandro

AU - Quiros-Roldan, Eugenia

AU - Girardi, Enrico

AU - Mammone, Alessia

AU - Antinori, Andrea

AU - Saracino, Annalisa

AU - Bai, Francesca

AU - Rusconi, Stefano

AU - Magnani, Giacomo

AU - Castelli, Francesco

AU - Hsue, Priscilla

AU - Monforte, Antonellad Arminio

AU - Hallett, Timothy B.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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.

AB - 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.

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