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Clinical pharmacy and clinical trials (including case series)
Cost effectiveness of pharmacotherapeutic follow-up in HIV-positive patients to improve immune response
  1. R.C. Carnevale,
  2. C.G.R. Costa,
  3. C. Zanin,
  4. N.C. Braz,
  5. E.C. Pincinato,
  6. P.G. Mazzola,
  7. P. Moriel
  1. 1Faculty of Medical Sciences – University of Campinas (Unicamp), Clinical pathology department, Campinas, Brazil
  2. 2Universidade Presbiteriana Mackenzie, Pharmacy Faculty, São Paulo, Brazil

Abstract

Background Health costs are a global concern as the financial resources are limited. Identifying new practices that lead to economies in resources is a great challenge. Some studies have already indicated that pharmacotherapeutic follow-up (PFU) can decrease the costs, but more studies must be performed in this area to obtain more precise data.

Purpose To evaluate the cost effectiveness of PFU in HIV-positive outpatients, considering their immune response and costs generated by these patients to the health system.

Materials and methods A 1–year prospective controlled study with 68 HIV outpatients was performed in Brazil, with a systematic sample by quota controls paired according to random characteristics. Patients were allocated to the Control Group (CG) or Intervention Group (IG; receiving PFU). The authors counselled the patients based on the Pharmacist Workup of Drug Therapy (PWDT). The demographic characteristics and the costs generated by each patient (appointments, laboratory tests, procedures and hospitalisations) were obtained from the medical charts. The clinical outcomes of immune response measured were lymphocyte CD4+ higher than 200 cells/mm3 and absence of new infections during the study. The authors performed a cost effectiveness analysis using a decision tree analytical approach.

Results The patients were allocated to CG (n=30) and IG (n=30) and eighteen patients were discontinued. The intervention group improved in clinical immune response outcomes compared with the control group: lymphocyte CD4+ higher than 200 cells/mm3 (68.2 vs 63.7%) and absence of new infections (77.0 vs 50.0%), respectively. Mean total patient costs (range) were US$ 429.81 (22.45-1312.12) for the control group and US$ 418.13 for the intervention group (125.86-1589.33). Intervention was less costly and more effective than non-intervention.

Conclusions The pharmacoeconomic analysis suggests the study intervention may be effective, with a reduced overall cost to the health system.

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