Hospital-Based Health Care Service Utilization in Persons With HIV With or Without Mental Health and Substance Use...

A few large-scale studies have shown that among persons with HIV (PWH), mental health and substance use comorbidities can increase the likelihood of hospital-based treatment. However, there has no evidence about the reasons for the increases in hospital-based health care utilization and the associated costs. We hypothesized that MHS+ (with) will have increased rates of hospital-based treatment utilization compared with MHS- (without), which will result in higher costs.

A validated claims-based case definition was used to identify PWH with MHS+ and MHS- as of March 31, 2020. Hospital and emergency department (ED) utilization were assessed over a 3-year follow-up period with respect to visit frequency, duration, reasons, and costs between MHS+ and MHS-.

MHS+ visited the ED or hospital (78%) more often than MHS- (48%; P < 0.01). This resulted in an average hospitalization cost of $58,190 (98,361) in MHS+ compared with $35,031 (64,203) in MHS- ( P < 0.01). Higher visit rates in MHS+ compared with MHS- included increased ED visits for mental health-related reasons (28% vs. 4%), physical conditions typically treated in ambulatory care (30% vs. 14%), physical trauma (45% vs. 19%), and medication complications (19% vs. 3%). ED admissions after acute mental health crises because of self-harm or suicide attempts were rare in both groups for less than 2% of cases.

Our outcomes highlight the significant burden of health care utilization and costs in MHS+ compared with MHS- among PWH. It emphasizes the need for targeted interventions to manage mental health and substance use comorbidities, potentially reducing health care utilization and associated costs among this population.