OBJECTIVES: In Brazil, there were approximately one million people living with HIV (PLHIV) in 2022 with an AIDS mortality rate of 4.2 deaths/100,000 in 2021. PLHIV increased by around 42% over the last 10 years (2012-2022). This study aimed to estimate the cost per HIV patient in the Supplementary Health System (SHS).

METHODS: A Delphi panel with 20 infectious diseases physicians was performed to capture the resources used in the treatment and follow-up of PLHIV, including management of comorbidities, co-infections, and complications. The cost was estimated using the price for drugs and procedures from positive reference reimbursement lists used by providers and HMOs. The antiretroviral drug costs weren’t included in the analysis because they are fully provided by the Brazilian public health system (SUS).

RESULTS: The most common regimen is tenofovir disoproxil (TDF) + lamivudine (3TC) + dolutegravir (DTG) in first line, TDF + 3TC + darunavir/ritonavir (DRV/r) in second line and DRV/r + DTG + etravirine (ETR) in third line treatment.

Diagnosis, monitoring, and clinical examinations to switch antiretroviral therapy were estimated to have a cost per patient of BRL 4,932.35, BRL 2,889.20, and BRL 1,598.95 respectively. Comorbidities and coinfections costs incurred recurrent weighted average annual costs of BRL 1,830.61 and BRL 984.48 respectively. Hospitalized patients were estimated an average length of stay of 10 and 7 days for ward and ICU, respectively which accounts for BRL 1,799.00 and BRL 7,398.58, adding substantial costs in the SHS, specially for AIDS patients.

CONCLUSIONS: Even though the antiretroviral treatments are fully provided by SUS, there are important recurrent costs associated with HIV in the SHS and mandatorily covered by HMOs, like hospitalization/ ICU stay which can increase substantially the economic burden. In this way and considering the huge size of PLHIV it is important to continue strengthen the HIV/ AIDS combination prevention strategy.