Although several studies have estimated monthly health care costs incurred by HIV patients, there is no information available on the use of health care regarding actual expenditures in the current HAART era, according to the authors of a recent report in Clinical Infectious Diseases (Epub February 22, 2006).

Using the UAB Studies of HIV/AIDS database, researchers at the University of Alabama in Birmingham (UAB), AL examined questions related the relationship among the cost components of care and evaluated how a change in clinical status affected cost expenditures over a period of one year.

The patient population was comprised of HIV patients at the UAB HIV clinic. The retrospective analysis targeted patient visits from March 1, 2000 to March 1, 2001.

The 2001 average wholesale price was used to determine medication expenditures. 2001 Medicare diagnostic related group reimbursement rates were used to determine hospitalization expenditures. Finally, 2001 Medicare current procedural terminology reimbursement rates were used to determine clinic expenditures.

Results

Among the 635 patients, total annual expenditures for patients with CD4⁺ cell counts <50 cells/microliter ($36,533 per patient) were 2.6-times greater than total annual expenditures for patients with CD4⁺ cell counts >350 cells/microliter ($13,885 per patient), primarily because of increased expenditures for non-antiretroviral medication and hospitalization.

Expenditures for HAART were relatively constant at ~$10,500 per patient per year across CD4⁺ cell count strata.

Outpatient expenditures were $1558 per patient per year; however, the clinic and physician component of these expenditures represented only $359 per patient per year, or 2% of annual expenses.

Health care expenditures for patients with HIV infection increased substantially for those with more-advanced disease and were driven predominantly by medication costs (which accounted for 71%–84% of annual expenses).

Based on these findings, the authors conclude, “Physician reimbursements, even with 100% billing and collections, are inadequate to support the activities of most clinics providing HIV care.”

“These findings have important implications for the continued support of HIV treatment programs in the United States.”

Reference
RY Chen, M Saag and others. Distribution of Health Care Expenditures for HIV-Infected Patients. Clinical Infectious Diseases 42. Epub  February 22, 2006.