861 
The Direct Cost of AIDS Care in the Era of HAART
H B Krentz*1, and M J Gill2
1Southern Alberta Clinic, Calgary, Canada and 2Univ. of Calgary, Alberta, Canada
Background: The incidence of
AIDS has decreased since the advent of highly active antiretroviral
therapy (HAART), however, its prevalence has increased as patients are living
longer after an AIDS diagnosis. We wished to measure and compare the direct
costs of providing care to HIV-positive patients with and without an AIDS
diagnostic illness.
Methods: The direct medical
costs of all patients presenting for HIV care at the Southern Alberta Clinic
(SAC), Calgary, Canada between April 1996 and April
2002 were included. SAC is the regional HIV care center for all HIV infected
patients living in southern Alberta.
Detailed sociodemographic, clinical, and direct costing data (i.e. all drug,
outpatient, inpatient, and home care costs) were collected for each patient. A
patient was considered to have AIDS if they were diagnosed with one of the 21
AIDS-defining illness. Mean costs are presented as cost
per patient per month in 2002 Canadian dollars.
Results: Between 1996 and
2002 the incidence of AIDS in southern Alberta
decreased from 119/1000 HIV patients per year to 40/1000 whereas the yearly
prevalence remained stable at 22% of the HIV population. In 1994 prior to HAART
18% patients receiving care at SAC survived 36 months after an AIDS diagnosis;
in 2000, 71% achieved 36 month survival.
Within the region the cost of providing care to AIDS patients accounts
for 32% of the annual total direct costs of all HIV care. The mean cost per
patient per month for AIDS patients was 64% higher (1528 vs 932)
than for non-AIDS patients. Drug, outpatient, inpatient, and home care costs
were 55%, 40%, 143%, 288% higher in AIDS patients respectively. These
differences persist even when controlling for CD4 count. After the arrival of
HAART mean costs per patient per month initially converged between AIDS and
non-AIDS patients, however, costs have since diverged.
Conclusions: The direct
costs of AIDS care remains significantly higher than for non-AIDS patients and
comprises a disproportional amount of the HIV care budget. Delaying or
preventing AIDS remains economically as well as clinically important. Projected
prevalence rates of AIDS need to be addressed when making any economic
prediction on HIV care costs.
Keywords: AIDS; Health Economics; Direct Costs
