What are the drivers of high-cost HIV patients?

Area of Science:

• Public Health
• Health Economics
• Infectious Diseases

Background:

• Identifying high-cost patient populations is crucial for optimizing healthcare resource allocation.
• Understanding the drivers of elevated healthcare costs in patients with HIV (PWH) can inform targeted interventions.

Purpose of the Study:

• To identify "high-cost" patients with HIV (PWH) in Southern Alberta.
• To determine the sociodemographic, clinical, and healthcare utilization factors associated with higher costs of HIV care.

Main Methods:

• Retrospective analysis of sociodemographic, clinical, and healthcare utilization data for all active PWH at the Southern Alberta HIV Clinic in 2017.
• Direct care costs, including antiretroviral drugs (ARV), outpatient visits, and hospital admissions, were calculated from a payer's perspective.
• Patients were categorized into cost groups: top 5% (high-cost), top 20%, middle 60%, and bottom 20%.

Main Results:

• High-cost PWH were older, more likely Caucasian or Indigenous Canadian, and acquired HIV through intravenous drug use (all p < 0.05).
• These patients exhibited lower nadir CD4 counts, increased comorbidities, missed clinic appointments, experienced ARV interruptions, and developed more ARV resistance (p < 0.01).
• The median annual cost for high-cost PWH was US$29,902, accounting for 14% of total costs and 84% of inpatient costs, with hospitalizations comprising 58% of their expenses.

Conclusions:

• High-cost PWH are a distinct group with identifiable sociodemographic and clinical characteristics driving their healthcare utilization.
• Hospitalizations are a major cost driver for this population.
• Addressing social determinants of health and exploring novel ARV administration strategies may improve patient health and reduce healthcare expenditures.