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Effectiveness of Highly Active Antiretroviral Therapy (HAART) in Veterans Affairs Medical Centers (VAMC) from 1996 - 1999 M. B. Goetz*1, S. Berman2, A. Morreale3, M. Ing4, D. Eldridge4, J. Justis2, and E. Lott1.
1VA Greater Los Angeles, Univ. of California at Los Angeles; 2VA Long Beach, Univ. of California, Irvine, Long Beach, CA; 3VA San Diego, Univ. California at San Diego; and 4VA Loma Linda, Loma Linda Univ., CA Objective: To determine the association between use of HAART and outpatient pharmacy costs, days of acute inpatient hospitalization, and mortality from the 1st quarter (Q) of FY1996 through the 4th Q of FY1999.
Methods: Analysis of pharmacy, acute hospitalization, and mortality data automatically collected in the local VA HIV Registry databases for the Los Angeles, San Diego, Long Beach, and Loma Linda VAMCs. An all inclusive rate per inpatient day of $1,046/day (based on upon VA costs) was used to estimate the costs of inpatient care on the acute medical, surgical and neurology wards and ICUs.
Results: Although the total number of patients receiving care increased from 865 to 1128 per Q, the proportion of patients with clinical AIDS or CD4 counts <200 did not significantly change. The patient cost of anti-retroviral therapy increased from $139 to $1,163/Q. In contrast, the per patient cost of other pharmaceuticals decreased from $370 to $250/Q, and the total number of inpatient days on the acute medical, surgical, and neurology units decreased from 1705 to 930/Q. Correspondingly, the percentage of all acute hospital days attributable to the care of HIV-infected patients decreased from 2.7% to 1.9% During the study period, the combined per patient outpatient pharmaceutical costs and acute hospitalization costs decreased from $2,565 to $2,287/Q. Finally, the total number of recorded deaths of HIV-infected patients decreased from 40 in the 1st Q of FY1996 to 20 in the final Q of FY1999. Of note, the rate of inpatient hospitalization and mortality have not decreased since the 4th Q of FY1997, while pharmaceutical costs have continued to increase.
Discussion: HAART continues to provide measurable clinical and economic benefit in the VA, a public hospital system which cares for ~5% of adult AIDS patients in the USA. However, the continued stable rates of hospitalization and mortality demonstrate the need for more effective medical regimens. Continued analysis of data such as these are necessary to gauge the long-term effectiveness of HAART in clinical practice.
Key Words: Cost-Effectiveness, HAART, Mortality
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