# Resource Use and Cost Associated With Cardiovascular, Renal, Bone, and Neuropsychiatric Comorbidities in People With HIV in Spain

## TL;DR

This study estimates the healthcare costs and resource use for non-HIV comorbidities in people with HIV in Spain, projecting a significant financial impact due to long-term ART use.

## Contribution

The study introduces a model to estimate the economic impact of non-HIV comorbidities in people with HIV in Spain, projecting future costs under different ART toxicity scenarios.

## Key findings

- In 2024, healthcare costs for cardiovascular, renal, bone, and neuropsychiatric comorbidities in PLWH in Spain were estimated at €83 million, €48 million, €55 million, and €97 million, respectively.
- By 2034, the number of PLWH with these comorbidities is projected to increase significantly, with an additional €900 million to €1400 million in costs if ART toxicity increases comorbidity prevalence.
- Long-term use of specific ART regimens with higher toxicity is identified as a key driver of rising healthcare costs for non-HIV comorbidities.

## Abstract

Background: Antiretroviral therapies (ART) have significantly improved the life expectancy of people with HIV (PLWH). However, chronic immune activation and some ART regimens may increase the prevalence of non-HIV comorbidities, such as cardiovascular, renal, bone, and neuropsychiatric conditions. These comorbidities increase healthcare resource utilization and costs for the Spanish National Health System (NHS), yet data on their economic impact remain scarce. Objective: To estimate the healthcare resource use and costs associated with cardiovascular, renal, bone, and neuropsychiatric comorbidities in PLWH from the Spanish NHS perspective and to simulate the financial impact of a potential prevalence increase due to ART toxicity. Methods: An Excel-based model was used to compare a current scenario using national epidemiological data and an alternative scenario with increased comorbidity prevalence due to ART toxicity. Two cohorts were analyzed: PLWH diagnosed for less than 10 years and those diagnosed for 10 years or more. Epidemiological and healthcare utilization data were collected from the literature and validated by an expert panel. Direct healthcare costs, including hospitalizations, tests, medical visits, and emergency care, were estimated and discounted at a 3% annual discount rate. Results: In 2024, 139 390 PLWH would be living in Spain, with 17 046 having cardiovascular, 7752 renal, 17 700 bone, and 16 207 neuropsychiatric comorbidities, predominantly affecting patients diagnosed for at least 10 years. By 2034, these figures will rise to 33 555, 15 391, 33 950, and 27 388, respectively, with increases observed in both cohorts. Estimated 2024 healthcare costs were €83 million, €48 million, €55 million, and €97 million for cardiovascular, renal, bone, and neuropsychiatric comorbidities, respectively. The alternative scenario with increased comorbidities prevalence projected an additional €900 million to €1400 million. Discussion: The projected increase in the prevalence of cardiovascular, renal, bone, and neuropsychiatric comorbidities among PLWH represents a significant challenge for the Spanish NHS, primarily driven by long-term use of specific ART regimes associated with higher toxicity profiles. Conclusion: Non-HIV comorbidities pose a growing economic challenge. Selecting lower-toxicity ART regimens and preventive strategies will be crucial to mitigating financial impact.