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Contemporary costs of HIV healthcare in the HAART era
Kelly A Gebo1, John A Fleishman, Richard Conviser
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. kgebo@jhmi.edu
Insights
HIV care remains costly in the US, with annual expenditures averaging $19,912 per person in 2006. Medications constitute the largest cost, particularly for patients with higher CD4 counts.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Management
Background:
- HIV healthcare costs have not been updated since 1996-1998.
- Previous estimates indicated high expenditures for HIV management.
Purpose of the Study:
- To provide updated estimates of HIV management expenditures in the United States.
- To analyze HIV care costs based on CD4 cell count strata.
Main Methods:
- A cross-sectional review of 14,691 adult HIV-infected patients' medical records across 10 HIV Research Network sites in 2006.
- Assessment of inpatient days, outpatient visits, and medication costs.
- Expenditure estimation stratified by CD4 cell count (≤50, 51-200, 201-350, 351-500, >500 cells/µL).
Main Results:
- The mean annual total expenditure per person for HIV care was $19,912.
- Expenditures were highest for patients with CD4 counts ≤50 cells/µL ($40,678) and lowest for those with counts >500 cells/µL ($16,614).
- Medications represented the majority of costs, except for patients with CD4 counts ≤50 cells/µL, where inpatient costs were highest.
Conclusions:
- HIV healthcare in the US remains expensive.
- Medications are the primary driver of HIV care costs.
- Increasing HIV survival may lead to rising costs that require future monitoring.
Background:
The delivery of HIV healthcare historically has been expensive. The most recent national data regarding HIV healthcare costs were from 1996-1998. We provide updated estimates of expenditures for HIV management.
Methods:
We performed a cross-sectional review of medical records at 10 sites in the HIV Research Network, a consortium of high-volume HIV care providers across the United States. We assessed inpatient days, outpatient visits, and prescribed antiretroviral and opportunistic illness prophylaxis medications for 14 691 adult HIV-infected patients in primary HIV care in 2006. We estimated total care expenditures, stratified by the median CD4 cell count obtained in 2006 (≤50, 51-200, 201-350, 351-500, >500 cells/microl). Per-unit costs of care were based on Healthcare Cost and Utilization Project (HCUP) data for inpatient care, discounted average wholesale prices for medications, and Medicare physician fees for outpatient care.
Results:
Averaging over all CD4 strata, the mean annual total expenditures per person for HIV care in 2006 in three sites was US $19 912, with an interquartile range from US $11 045 to 22 626. Average annual per-person expenditures for care were greatest for those with CD4 cell counts 50 cell/microl or less (US $40 678) and lowest for those with CD4 cell counts more than 500 cells/microl (US $16 614). The majority of costs were attributable to medications, except for those with CD4 cell counts 50 cells/microl or less, for whom inpatient costs were highest.
Conclusion:
HIV healthcare in the United States continues to be expensive, with the majority of expenditures attributable to medications. With improved HIV survival, costs may increase and should be monitored in the future.
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