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3.0 Adherence support and health economics

In meeting the funding requirements for HAART, it has been difficult for commissioners and providers to fund any new developments other than direct drug costs. However, if one considers the financial consequences of low adherence (and treatment failure) as outlined above, it is likely that a relatively small investment in adherence support measures may have a marked benefit in the avoidance of unnecessary additional costs.

Few studies have investigated the cost implications of adherence support interventions in HIV disease, and none have investigated this in the UK. One study reported that fully adherent patients had fewer hospital admissions19, while another demonstrated that direct hospital costs can be minimised by maintaining viral loads at undetectable levels20. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression21. This document therefore recommends strategies to improve the cost effectiveness of currently prescribed HAART regimens.