915 The High Cost of Providing Medical Care to Patients Who Present Late (<100/mm3) with HIV Infection M. J. Gill*, H. B. Krentz, C. M. Auld Univ of Calgary, Canada
Background: The total costs for medical care of HIV infection have been broadly described. We wished to measure the direct costs of providing care in the 12 months (mos) following presentation of those patients (pts) presenting with a CD4 count of <100/mm3 (e.g., late presenters to those with a CD4 count >100/mm3.
Methods:The direct medical costs of all pts presenting for HIV care in southern Alberta between April 1996 and April 2001 were included. Detailed sociodemographic, clinical, and direct costing data were collected for each pt. Costs collected included all drugs, lab tests, outpatient, inpatient, and home care for 12 months following diagnosis. Mean costs are presented as cost PPPM (per pt per month) in 2001 Canadian dollars.
Results: Of the 262 pts presenting with HIV infection, 60 (23%) had a CD4 count < 100/mm3. Sex and ethnicity did not exhibit statistical differences but age, level of education, and exposure category did. Older pts with more than a high school level of education and pts whose exposure category was MSM (men having sex with men) were statistically more likely to present late. The reason for HIV testing was triggered by AIDS-defining illnesses for 73% of the late presenters while illness was listed in only 6% for the other presenters. The mean cost PPPM for late presenters was $2,178 for the first 12 mos following diagnosis; this is more than 2.5 times the cost for the other presenters ($794 PPPM) with higher CD4 counts. In-patient hospital costs relating directly to HIV account for 45% of all direct medical care costs for late presenters and are 17 times higher ($949 vs $54 PPPM) than for the other presenters.
Conclusion: In our population older, better educated pts with a exposure category of MSM were more likely to present late in their disease. Such pts incurred direct medical costs for the 12 mos following diagnosis that far exceed those presenting earlier. Most of these costs are attributable to care of acute illnesses associated with treatment of the immediate AIDS defining disease. Testing and early diagnosis in those at risk for HIV is still medically and economically very important.
