537
Contemporary Costs of HIV Health Care in the HAART Era
Kelly Gebo*1, J Fleishman2, R Conviser3, J Hellinger4, F Hellinger2, P Keiser5, P Gaist6, R Moore1, and for the HIV Res Network
1Johns Hopkins Univ, Baltimore, MD, US; 2Agency for Hlthcare Res and Quality, Rockville, MD, US; 3Hlth Resources and Svcs Admin, HIV/AIDS Bureau, Rockville, MD, US; 4Community Med Alliance, Boston, MA, US; 5Parkland Hlth and Hosp Systems, Dallas, TX, US; and 6NIAID, NIH, DHHS, Bethesda, MD, US
Background: Historically, delivery
of HIV health care in the United
States has been expensive. The most recent
national data regarding HIV health care costs come from 1996 to 1998,
reflecting the introduction and early use of HAART. Newer data are needed to
determine the costs of HIV care with contemporary HIV management.
Methods:
In 2003, 951 HIV+ adult
patients were randomly selected at 14 HIV community and academic sites across
the United States
for face-to-face interviews of health care utilization. Comprehensive
data were obtained regarding all medications used (prescribed and over the
counter), inpatient, outpatient, and emergency department utilization. Computation
of costs was based on: Medications (Red Book average wholesale price –15%);
inpatient days, outpatient visits, and emergency department (HIV Cost and Services
Utilization Study [HCSUS] costs). Costs were inflation-adjusted to 2003 dollars,
annualized and stratified by the first CD4 level obtained in 2003.
Results: Patients were male
(68%), of minority ethnicity (52% African American, 14% Hispanic), with median age
of 46 (20 to 85). HIV risk groups were 37% men who have sex with men (MSM), 27%
heterosexual, 36% injecting drug users (IDU); 85% were on HAART. Average annual
costs of care are summarized in the table. CD4 was a more significant predictor
of cost than was sex, age, or race. On average, total costs were $6335 higher (p <0.05) for IDU thab
other HIV risk groups.
|
|
CD4
Stratum (cells/mL)
|
|
|
<50
|
50-200
|
200-500
|
> 500
|
|
Antiretroviral
costs
|
$16,830
|
$14,853
|
$12,424
|
$11,674
|
|
Other
medication costs
|
$7,887
|
$5,180
|
$3,305
|
$2,691
|
|
Inpatient
costs
|
$27,473
|
$10,549
|
$6,827
|
$3,978
|
|
Outpatient
costs
|
$4,729
|
$4,506
|
$3,927
|
$3,151
|
|
Emergence
department costs
|
$644
|
$394
|
$364
|
$374
|
|
Total
costs
|
$57,565
|
$35,483
|
$26,848
|
$21,869
|
Conclusions: HIV health care
in the United States
continues to be expensive, with the majority of costs attributable to
medications, until the CD4 level is <50, when inpatient costs are highest. This
compares with the 1996-1998 U.S. estimated costs (HCSUS) ranging from $28,128
(CD4 <50) to $6384 (CD4 >500). Higher costs in the higher CD4 strata
compared to 1996-1997 emphasizes the effectiveness of maintenance HAART in
increasing the CD4 level. With improved HIV survival, it is also likely that
some of the contemporary costs in all CD4 strata are due to non-HIV
comorbidities. For example, this may explain the higher costs for patients with
IDU. Future analysis will assess the specific contributions of other comorbidities.
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