HIV and Hepatitis.com Coverage of the
13th Annual Conference on Retroviruses and Opportunistic Infections
February 5 - 8, 2006, Denver, CO

HIV Health Care in the US Is Expensive, Primarily Due to Costs for Anti-HIV Medications

The most recent information concerning the cost of HIV health care in the US is derived from statistics compiled 1996-1998, which reflects the costs of early use of HAART. The aim of the current retrospective study was to evaluate HIV health care costs that reflect the use of more recent HIV management.

The investigators conducted interviews of health care use (including drug treatment) among 914 adult patients who were randomly selected from 14 HIV community and academic medical centers. They collected data on all medications (including over-the-counter agents), inpatient, outpatient, and use of emergency care facilities.

The authors based their cost computation on the Red Book average wholesale price -15% for medications, inpatient days, outpatient visits, and emergency department costs. They then adjusted these costs to 2003 dollars annualized and stratified by the first CD4 level obtained in 2003.

Results

·         Patients were 68% male, 52% African American and 14% Hispanic, median age 46.

·         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.

·         Total costs were on average $6335 higher for IDU than other HIV risk groups.

Table

 

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

In conclusion, the study authors write, “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.”

02/17/06

Reference
K Gebo and others (for the HIV Res Network). Contemporary Costs of HIV Health Care in the HAART Era. 13th Conference on Retroviruses and Opportunistic Infections. Denver, CO. February 5-8, 2006. Abstract 537.