Early Mortality and Health Care Costs in Patients Recently Diagnosed With Kaposi Sarcoma at the National Cancer Institute, Mexico City.

Abstract

Background: Kaposi sarcoma (KS) is a marker of advanced HIV disease; it is still the most frequent AIDS-associated malignancy in Mexico despite universal access to antiretroviral therapy, reflecting a gap in early HIV diagnosis.

Methods: The objectives of the study were to describe people with HIV with KS who died within 30 days of admission at INCan (National Cancer Institute) and to quantify resources and years of life lost (YLL). We collected demographic data, HIV-related variables, all diagnostic and therapeutic procedures, hospitalizations, and estimated YLL and disability-adjusted life years.

Results: Eighteen (6.7%) people with HIV with KS from 270 patients admitted at INCan from 2014 to 2021 were included. The median age was 31 years (IQR 27-36), and the median days from admission to death and from HIV diagnosis to death were 15 (IQR, 6-24) and 73 (IQR, 30-857), respectively. Upon admission, the median HIV viral load was 314 476 copies/mL (IQR, 140 709-695 613); CD4+ T cells, 93 cells/mL (IQR 35-124); and CD4/CD8 ratio, 0.08 (IQR, 0.06-0.12). Coinfections were diagnosed in 14 (77.7%) patients. The average expenditure per patient was US $7685.99 USD, and the total YLL was 737.4 with a median 42 years (IQR, 37.7-47) per patient. The total care cost was US $183 947.48, equivalent to a screening program in key populations, which would have allowed the early detection of 1227 cases and saved 8410 disability-adjusted life years.

Conclusions: Reinforcement of early HIV infection detection in key population programs should be prioritized to reduce KS-associated deaths and YLL and for rational use of health budgets.