Abstract
Introduction: Advances in science have allowed the use of antiretrovirals (ARVs) to reduce the mortality rate related to the disease and improve the quality of life of individuals affected by HIV in a few years. Despite the numerous advances in this regard, there is currently little research focused on a more in-depth analysis of the approval of ARVs worldwide. Although the scope of what was categorized as “health technology” was broad, ATS initially focused its attention on product technologies, such as medicines, materials and equipment. Tracing a trajectory over the last decades, ATS has expanded its presence and visibility, transcending the old continent to echo in global corners, further promoting developing nations. The objective of this study was to evaluate the budgetary impact in a global scenario of approvals of ARVs for HIV treatment. Methods: This is a budgetary impact study based on the database of an ecological study of the global scenario of HIV treatment with ARVs. The direct costs of medication for HIV/AIDS treatment were considered, following the therapeutic regimen established by the protocols in each region/country analyzed: Brazil, the United States, Europe, and Australia. The costs were obtained by the Chamber of Regulation of the Drug Market (CMED) for Brazil, the Public Data Base for Medical Products for Europe, representing the entire European Union, and for Australia, institutions such as the Pharmaceutical Benefits Scheme (PBS) and the Australasian Society for HIV, Viral Hepatitis, and Sexual Health Medicine (ASHM) were used. The IO sensitivity analysis was performed for 10,000 interactions in the Monte Carlo simulation, using Microsoft Excel® with Addin @Risk v8.05 from Palisade Corporation®. Results: The average direct costs for Australia were R$20,012.15 (95% CI, 10,006.08 - 30,018.23) around (0.333 - 1.001) per patient in a population of 30,000 infected; Brazil R$47,415.98 (95% CI, 23,707.99 - 71,123.97) around (0.028 - 0.085) per patient in a population of 841,000 infected; United States R$39,204.73 (95% CI, 19,602.36 - 58,807.09) approximately (0.019 - 0.057) per patient in a total of 1,031,191 infected.; Europe R$21,678.00 (95% CI, 10,839.00 - 32,517.00) approximately (0.004 - 0.012) per patient in a total of 2,800,000 infected. The budgetary impact assessment is under construction, to be considered for this the prevalence of the disease, pent-up demands and fatality rate. Discussions and conclusions: It is concluded that, of the different protocols governing treatment, the USA was the country that had the most new technologies incorporated, with the highest average cost for Brazil and the lowest for Australia. However, analysis of pharmacoeconomic and epidemiological data from different regions provides valuable information for decision-making in favor of HTA in HIV treatment. These data highlight the importance of efficient resource allocation, the need to balance costs and effectiveness, and the urgency of addressing inequalities in access coverage. By improving access, emphasizing prevention and adopting an evidence-based approach, it is possible to optimize budgetary impact and achieve more effective results in HIV control.
