HIV economic burden of illness in the Veterans Health Administration population

The objective was to assess the human immunodeficiency virus (HIV) economic burden of illness in the Veterans Health Administration (VHA) population. Adults (aged 18-64 years) with a HIV diagnosis (International Classification of Diseases 9th Revision, Clinical Modification [ICD-9-CM] code 042.x, V08) from 1 June 2007 to 31 May 2012 were selected from VHA Medical SAS(®) data-sets. Continuous VHA insurance coverage 12-month pre- and postindex date, with no antiretroviral therapy (ART) prescriptions within 180 days pre-index date, was required for treatment-naive (TN) HIV-infected patients. One baseline CD4 count or HIV viral load measured within three months after HIV diagnosis or one ART anchor drug claim postindex date was required for group comparison. All-cause health-care costs and utilizations were evaluated and stratified by CD4 cell count, viral load, nonnucleoside reverse transcriptase inhibitor (NNRTI) anchor drugs (efavirenz/non-efavirenz), and ART (NNRTI/PI/INSTI/CCR-5 Antagonist-based) regimen cohorts. The overall economic burden was compared between HIV-infected vs. non-HIV-infected patients. CD4 count, viral load, and treatment patterns and the associated costs were compared among TN patients. A 1:1 propensity score matching (PSM) was used to adjust for baseline differences. A total of 25,648 HIV-infected patients were identified (mean age 51; 96.4% male; 49.7% non-Hispanic black) of which 11,371 were TN. HIV-infected patients incurred higher PSM-adjusted total costs than non-HIV-infected patients ($25,232 vs. $10,206, p < 0.0001). Total costs for TN with CD4 cell counts ≤50 cells/mm(3) were higher than all other CD4 cell strata (p < 0.001). Total costs for TN with viral loads >100,000 copies/mL were higher than all other viral load categories (p < 0.001). Efavirenz-treated patients incurred higher ART-related ($8663 vs. $2846, p = 0.0266), but lower non-ART-related ($2339 vs. $6628, p = 0.0042) pharmacy costs than non-efavirenz patients. NNRTI-based cohort incurred lower total costs than protease inhibitor-based ($32,829 vs. $39,073, p = 0.0005) but no significant differences compared to integrase strand transfer inhibitor cohorts. This study offers new health-care costs and resource utilization estimates associated with the burden of HIV in the VHA population.