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

Eduard J. Beck (), Sundhiya Mandalia (), Platon Yfantopoulos (), Agathe Leon (), Marie J. Merino (), Felipe Garcia (), Marie Wittevogel (), Ludwig Apers (), Ivana Benkovic (), Sime Zekan (), Josip Begovac (), Ana S. Cunha (), Eugenio Teofilo (), Goncalo Rodrigues (), Margarida D. F. Borges (), Duncan Fatz (), Jamie Vera () and Jennifer Whetham ()
Additional contact information
Eduard J. Beck: NPMS-HHC CIC
Sundhiya Mandalia: NPMS-HHC CIC
Platon Yfantopoulos: NPMS-HHC CIC
Agathe Leon: University of HC-IDIBAPS
Marie J. Merino: University of HC-IDIBAPS
Felipe Garcia: University of HC-IDIBAPS
Marie Wittevogel: Institute of Tropical Medicine (ITM)
Ludwig Apers: Institute of Tropical Medicine (ITM)
Ivana Benkovic: University Hospital for Infectious Diseases (UHID)
Sime Zekan: University Hospital for Infectious Diseases (UHID)
Josip Begovac: University Hospital for Infectious Diseases (UHID)
Ana S. Cunha: Centro Hospitalar De Lisboa Central, EPE (HC-CHLC)
Eugenio Teofilo: Centro Hospitalar De Lisboa Central, EPE (HC-CHLC)
Goncalo Rodrigues: Centro Hospitalar De Lisboa Central, EPE (HC-CHLC)
Margarida D. F. Borges: Centro Hospitalar De Lisboa Central, EPE (HC-CHLC)
Duncan Fatz: Brighton and Sussex University Hospitals NHS Trust (BSUHT)
Jamie Vera: Brighton and Sussex University Hospitals NHS Trust (BSUHT)
Jennifer Whetham: Brighton and Sussex University Hospitals NHS Trust (BSUHT)

PharmacoEconomics, 2022, vol. 40, issue 12, No 7, 1235-1246

Abstract: Abstract Objective 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.

Date: 2022
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DOI: 10.1007/s40273-022-01193-z

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