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Inpatient, Outpatient, and Pharmacy Costs in Patients With and Without HIV in the US Veteran's Affairs Administration
Scott Sutton1,2, Joseph Magagnoli1,2, Tammy Cummings2
11 Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
Insights
Human immunodeficiency virus (HIV) patients incur significantly higher medical costs, including pharmacy, inpatient, and outpatient expenses, compared to individuals without HIV. This national study highlights the economic burden associated with HIV care within the Veterans Affairs system.
Area of Science:
- Health Economics
- Infectious Diseases
- Public Health
Background:
- The economic impact of managing chronic conditions like human immunodeficiency virus (HIV) is a critical public health concern.
- Understanding healthcare cost disparities is essential for resource allocation and policy development within healthcare systems.
Purpose of the Study:
- To evaluate the association between human immunodeficiency virus (HIV) and medical costs, including inpatient, outpatient, and pharmacy expenditures.
- To compare healthcare costs between a national cohort of HIV-infected Veterans and matched non-HIV controls within the Veterans Affairs (VA) Administration system.
Main Methods:
- Utilized claims data from January 2000 to December 2016 from the VA Informatics and Computing Infrastructure and VA Health Economics Resource Center.
- Included 26,526 HIV-positive Veterans and 53,052 matched non-HIV controls, with HIV diagnosis confirmed by ICD codes and antiretroviral therapy prescription.
- Employed exact matching for controls based on race, sex, and birth date, followed by multivariable logistic and gamma generalized linear models for cost analysis.
Main Results:
- HIV-positive patients demonstrated significantly higher odds of incurring pharmacy costs (OR = 2286.45), outpatient costs (4-fold), and inpatient costs (2-fold) compared to controls.
- Adjusted models revealed that HIV-positive individuals had substantially higher total medical costs (almost 4-fold), pharmacy costs (17-fold), and outpatient costs (almost 2-fold).
- The study cohort comprised 79,578 patients, with an average age of 49.3 years, 97% male, and diverse racial representation (38% Black, 32% White).
Conclusions:
- HIV infection is strongly associated with increased odds of incurring medical costs across all categories (pharmacy, inpatient, outpatient).
- HIV-positive patients experience significantly higher overall medical expenditures compared to their non-HIV counterparts.
- Findings underscore the substantial economic burden of HIV care and the need for continued healthcare resource optimization.
Objectives:
To evaluate the association between human immunodeficiency virus (HIV) patients and medical costs (inpatient, outpatient, pharmacy, total) using a national cohort of HIV-infected Veterans and non-HIV matched controls within the Veteran's Affairs (VA) Administration system.
Design:
This study used claims (January 2000 to December 2016) extracted from the VA Informatics and Computing Infrastructure and VA Health Economics Resource Center. Cases included Veterans with an International Classification of Diseases, Ninth Revision/International Classification of Diseases, Tenth Revision for HIV with at least 1 prescription for a complete antiretroviral therapy regimen (January 2000 to September 2016). Two non-HIV controls were exact matched on race, sex, month, and year of birth. All patients were followed until the earliest of the following: last date of VA activity, death, or December 31, 2016.
Results:
A total of 79 578 patients (26 526 HIV and 53 052 non-HIV) met all study criteria. The average age was 49.3 years, 38% were black, 32% were white, and 97% were male for both the HIV and control cohorts. Adjusted multivariable logistic regression models demonstrated that HIV was associated with higher odds of incurring a pharmacy cost (odds ratio = 2286.45, 95% confidence interval: 322.79-16 195.82), 4-fold, and 2-fold higher odds of incurring both outpatient and inpatient costs compared to the matched controls, respectively. In adjusted multivariable gamma generalized linear models, HIV-positive patients had an almost 4-fold, 17-fold, and almost 2-fold higher cost than matched controls in total, pharmacy, and outpatient costs, respectively.
Conclusions:
This study found an association between HIV-positive patients having higher odds of incurring a medical cost as well as higher medical costs compared to non-HIV controls.
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