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 US2018OECDpurchasingparitypricestoenablebetweencliniccomparisonsintermsofoutcomesandcosts.UnitcostswerelinkedtothemeanuseofservicesformedicallystablepeoplelivingwithHIV,beforeandafterimplementationofEmERGE.PrimaryoutcomemeasureswereCD4countandviralload;secondaryoutcomeswerepatientactivation(PAM13)andqualityoflife(PROQOL−HIV).Out−of−pocketexpendituredatawerecollected.Results:Therewere2251participants:87−93 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.info:eu-repo/semantics/publishedVersio