When Antiretroviral Adherence is High, Cost of Cardiovascular Disease is Lower

The cost burden of cardiovascular diseases in a population with human immunodeficiency virus (HIV) was significantly lower in times of high adherence to antiretroviral therapy, according to a study published in the European Journal of Preventive Cardiology. 

“There is a lack of studies that rigorously and systematically assess the economic burden of cardiovascular diseases related to the use of antiretroviral therapy,” researchers wrote in the study introduction. “We aimed to assess the association between adherence to antiretroviral therapy and economic burden of cardiovascular diseases in an HIV-infected population.” 

Using Taiwan's National Health Insurance Research Database for the years 2000 through 2011,  researchers identified 18,071 patients with HIV who were free of cardiovascular disease before their HIV diagnosis. They determined adherence to antiretroviral therapy based on patients’ medication possession ratio. 

In 2018 US dollars, the average annual medical cost for a base-case patient without cardiovascular disease was $3000, according to the study. Annual costs increased 41% with cerebrovascular disease, 33% with myocardial infarction, 30% with heart failure, 16% with arrhythmia, and 14% with ischemic heart disease. 

In years with high adherence to antiretroviral therapy, the cost impact of incident cardiovascular diseases was significantly lower compared with years of low adherence to antiretroviral therapy, the study showed. For example, having cerebrovascular diseases in a year of high adherence to antiretroviral therapy increased annual costs by 21%. In years of low adherence, having cerebrovascular diseases spiked annual costs 259%. 

“The economic burden of incident cardiovascular diseases in an HIV-infected population was compelling and varied by the extent of using antiretroviral therapy,” researchers wrote. “A reduced economic impact of cardiovascular diseases was found in years when patients possessed a greater adherence to antiretroviral therapy.” 

—Jolynn Tumolo

Reference:

Liao CT, Yang CT, Chen PH, et al. Association of adherence to antiretroviral therapy with economic burden of cardiovascular disease in HIV-infected population. Eur J Prev Cardiol. 2021;28(3):326-334. doi:10.1177/2047487320908085