Background: Non-HIV infected patients with diabetes and hyperlipidemia incur higher healthcare costs. We evaluated whether HIV-infected patients (pts) who develop similar disorders on highly active antiretroviral therapy (HAART) also incur higher healthcare costs.

Methods: Pts were drawn from an ongoing, observational database study at UAB’s HIV clinic. Pts were included if they were seen between 3/1/00–3/1/01, had a CD4 count on 3/1/00 ±90 days, and had at least one follow-up visit or hospitalization between 6/1/00–3/1/01. Pts who developed lipodystrophy (LD) during the year (n = 35) were excluded. LD was defined as: LD, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, or hyperlipidemia on problem list; or non-fasting serum glucose > 200 mg/dL, cholesterol > 240 mg/dL, or triglycerides > 400 mg/dL. Pts meeting any of these criteria before receiving HAART were excluded. Mean costs were determined using 2001 Medicare reimbursement rates by CPT and DRG codes. Medication costs were based on average wholesale price.

Results: N = 551. 77% Male, 58% Caucasian, 62% MSM. Median age 40 years, median baseline CD4+ cell count 365/μL, viral load 287 copies/mL.

 

Cost Category	LD (n=299)	NonLD (n=252)	P value (ANOVA)
Hospitalization	$2,150	$3,668	0.41
Home Health	$125	$9	0.47
Physician	$379	$312	0.01
Imaging	$105	$69	0.13
Procedures	$240	$165	0.10
Laboratory	$876	$722	<0.0001
ART	$11,369	$9,222	<0.0001
NonART	$4,855	$3,532	0.0019
Total	$20,099	$17,698	0.05

 

After adjusting for CD4 count, pts with LD have significantly increased healthcare costs compared to pts without LD due to increased physician, laboratory, ART, and nonART costs.

Conclusions: Total healthcare costs of HIV pts with LD significantly exceed those of pts without LD primarily due to greater physician, laboratory, and medication costs.