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Efficiency of the EmERGE Pathway of Care in Five European HIV Centres

2022Journal article Open access
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dc.contributor.authorBeck, EJ
dc.contributor.authorMandalia, S
dc.contributor.authorYfantopoulos, P
dc.contributor.authorLeon, A
dc.contributor.authorMerino, MJ
dc.contributor.authorGarcia, F
dc.contributor.authorWittevogel, M
dc.contributor.authorApers, L
dc.contributor.authorBenkovic, I
dc.contributor.authorZekan, S
dc.contributor.authorBegovac, J
dc.contributor.authorCunha, AS
dc.contributor.authorTeofilo, E
dc.contributor.authorRodrigues, G
dc.contributor.authorBorges, MDF
dc.contributor.authorFatz, D
dc.contributor.authorVera, J
dc.contributor.authorWhetham, J
dc.date.accessioned2023-05-04T12:10:55Z
dc.date.available2023-05-04T12:10:55Z
dc.date.issued2022
dc.description.abstractObjective: We aimed to calculate the efficiency of the EmERGE Pathway of Care in five European HIV clinics, developed and implemented for medically stable people living with HIV. Methods: Participants were followed up for 1 year before and after implementation of EmERGE, between April 2016 and October 2019. Micro-costing studies were performed in the outpatient services of the clinics. Unit costs for outpatient services were calculated in national currencies and converted to US$ 2018 OECD purchasing parity prices to enable between clinic comparisons in terms of outcomes and costs. Unit costs were linked to the mean use of services for medically stable people living with HIV, before and after implementation of EmERGE. Primary outcome measures were CD4 count and viral load; secondary outcomes were patient activation (PAM13) and quality of life (PROQOL-HIV). Out-of-pocket expenditure data were collected. Results: There were 2251 participants: 87-93% were male, mean age at entry was 41-47 years. Medically stable people living with HIV had outpatient visits in four sites which decreased by 9-31% and costs by 5-33%; visits and costs increased by 8% in one site, which had to revert back to face-to-face visits. Antiretroviral drugs comprised 83-91% of annual costs: the Portuguese site had the highest antiretroviral drug costs in US$ purchasing parity prices. Primary and secondary outcome measures of participants did not change during the study. Conclusions: EmERGE is acceptable and provided cost savings in different socio-economic settings. Antiretroviral drug costs remain the main cost drivers in medically stable people living with HIV. While antiretroviral drug prices in local currencies did not differ that much between countries, conversion to US$ purchasing parity prices revealed antiretroviral drugs were more expensive in the least wealthy countries. This needs to be taken into consideration when countries negotiate drug prices with pharmaceutical vendors. Greater efficiencies can be anticipated by extending the use of the EmERGE Pathway to people with complex HIV infection or other chronic diseases. Extending such use should be systematically monitored, implementation should be evaluated and funding should be provided to monitor and evaluate future changes in service provision.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationPharmacoeconomics . 2022 Dec;40(12):1235-1246pt_PT
dc.identifier.doi10.1007/s40273-022-01193-zpt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4509
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerlinkpt_PT
dc.subjectAmbulatory Carept_PT
dc.subjectDrug Costspt_PT
dc.subjectAdultpt_PT
dc.subjectFemalept_PT
dc.subjectHIV Infections* / drug therapypt_PT
dc.subjectHealth Expenditurespt_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectQuality of Lifept_PT
dc.subjectHSAC MEDpt_PT
dc.titleEfficiency of the EmERGE Pathway of Care in Five European HIV Centrespt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1246pt_PT
oaire.citation.issue12pt_PT
oaire.citation.startPage1235pt_PT
oaire.citation.titlePharmacoEconomicspt_PT
oaire.citation.volume40pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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