- Autores: Shaaban AN, Martins MRO
- Ano de Publicação: 2019
- Journal: Frontiers in Public Health
- Link: https://www.frontiersin.org/articles/10.3389/fpubh.2019.00266/full
HIV affects almost 37.9 million persons globally, and an estimated 1.7 million new HIV infections occur in 2018 (1). While HIV/AIDS is taking a devastating toll on populations’ health, lives and families, the disease is imposing a serious economic burden on governments (2–4) being classified as the greatest single financial burden on healthcare systems globally (5). This burden is predominantly due to the high payments of antiretroviral therapy (ART), hospitalizations, and associated opportunistic infections treatment (6, 7). In Portugal, HIV continues to be a major public health concern and HIV prevalence is among the highest in Europe (8, 9) with 41,000 individuals who are living with HIV, representing 0.5% of the total population (10) (see Table 1 for an informative overview of HIV/AIDS in Portugal). The country also still records annual rates of new HIV/AIDS diagnosis, which have been classified among the highest in the European Union (EU) (8). Admissions among HIV/AIDS patients still pose considerable challenges to the Portuguese national health system (5, 11). In Portugal, hospitalizations related to HIV/AIDS are some of the most expensive with an average daily cost of €825 and an average length of stay of 23 days, placing HIV/AIDS as the second greatest Major Diagnostic Category (MDC) (5, 12). In addition, and after the financial crisis that hit Portugal in 2011, the country went through strict fiscal austerity that resulted in budget cuts, reduction of spending on sensitive health sectors, and restructuring numerous public entities including the National AIDS Program (NAP) (12–14). It is important to know that the average cost of HIV treatment in Portugal is about 14,000 €/patient per year (6). The main cost driver is the antiretroviral medications (€ 9,598), followed by hospitalizations (€ 1,323). Treatment costs grow with the severity of disease from € 11,901, with a CD4 count more than 500, to € 23,351, with a CD4 count <50 (6). In other words, while cost related to antiretroviral remains constant over the course of the disease, the cost progression remains mainly linked to the associated hospitalizations and admissions related to HIV. Moreover, the shift of HIV infection from a fatal disease into a chronic illness carries substantial challenges to the health system. The introduction of antiretroviral therapy (ART) has dramatically increased the life expectancy of HIV patients (15–17). This modification in the natural evolution of HIV infection has led to a substantial increase in the financial burden and cost due to the net increase in the number of people living with HIV and the associated life-long treatment and comorbidities (16, 18).