Medications used for paediatric HIV infection in the USA, 1991-1992

Medications constituted the third largest health care expenditure for children infected with the human immunodeficiency virus (HIV). Previous literature had not investigated volume or cost of pharmaceuticals consumed by individual patients. The US Agency for Health Care Policy & Research (AHCPR) therefore sponsored the AIDS Cost & Services Utilization Survey (ACSUS) to measure utilization of health care services, including medications. Starting in 1991, it surveyed 100 children with AIDS and 41 HIV-infected children (via adult proxies) six times at quarterly intervals and collected their outpatient bills. These children reported using 5,634 prescriptions and had 5,026 bills. Children with AIDS reported more prescriptions than HIV-infected children. On the basis of CD4 counts and age, 14.2% of children had indications for antiretrovirals, but did not receive them; and 17.7% warranted PCP prophylaxis but did not receive it. Outpatient bills averaged $2,325 and inpatient bills averaged $7,725 per year. These amounts projected nationally to $48.2 million annually, mostly paid by Medicaid.