The Body Covers: The 36th Annual Meeting of the Infectious Diseases Society of America
The Short-Term Cost Benefit of Effective HAART
November 13, 1998
The authors examine further the cost benefits of providing maximally suppressive antiretroviral regimens during a period of increased protease-inhibitor use for the study period January 1996 (N=525) through December 1997 (N=723). The non-Medicaid/non-MediCal study population was privately insured, caucasian men (95%) living in HIV managed care areas in California and Texas. Suppressed patients were defined as those individuals who had an HIV-1 RNA < 400 copies/mL during each quarter of analysis during the two-year study period. Average monthly costs per HIV member (MPM = member per month costs) were calculated for both drug and non-drug costs and reported for both suppressed and non-suppressed patients. Prescription drug costs (88% were antiretrovirals) and non-drug costs (hospital, laboratory, home services, etc) were predominantly actual amounts submitted for claims.
The proportion of these patients with a non-detectable VL increased each quarter from 6% in the first quarter of 1996 to 56% in the last quarter of 1997. For both suppressed and non-suppressed patients, the average HIV MPM drug costs increased each quarter from about $600/month to ($950 - $1200), however there was no statistical difference between the drug costs between the two groups. The average HIV MPM non-drug costs per quarter decreased or both suppressed (from $400 to $120) and non-suppressed patients (from $800 to $400), however the non-drug costs for the non-suppressed were significantly higher. Overall, the average HIV MPM costs for the suppressed and non-suppressed patients remained relatively stable, however the average MPM costs for the suppressed (~$1050) was significantly lower than for the non-suppressed (~$1600).
Abstract 404: Impact of Increased PI Penetration and Correlation with a Decrease in Opportunistic Infection Incidence Rate or HIV Infected Population in a Ryan White Title III Funded Program
While the above data cannot be generalized to more marginalized populations who have traditionally not had accessible health care nor derived the same benefit from HAART as have white men, a companion poster described the OI incidence decrease associated with increased PI use in a more marginalized population in Dallas. While a cost analysis was not included, in other cost analysis studies of HIV, the decreased costs associated with PI use have been secondary to decreased hospitalization costs associated with preventing OIs. The study population (N=644) included 41% women and 51% were Black and 12% were Hispanic. All patients received their care in Ryan White-funded Commmunity Care Clinics. Mid-year penetration of PI use in the population was 2% (1995), 20% (1996), 41% (1997) and 51% (1998). During that same time, the OI incidence decreased from 22% in 1996 to 10% in 1998. OI incidence was similar for Blacks and Whites for each year of analysis, however was significantly higher for Hispanics. While OI incidence decreased in both Blacks and Whites from 1996 to 1997 (from ~22% to 8%), OI incidence increased marginally for Hispanics (from 22% to 29%); no comparable PI use data were available for each race/ethnicity.
The combination of the two presentations continue to provide support for the short-term cost benefit of using effective HAART, both in white men who have derived the best survival benefits from such therapies, as well as for more marginalized populations in terms of decreased costly OIs. Still unanswered is whether these cost benefits will be sustained as patients fail therapies, develop adverse consequences from these therapies, or survive longer and develop more costly non-HIV complications. This may be particularly relevant for marginalized populations in primary care who also have increased age-specific morbidity and mortality for non-HIV medical complications (e.g. hypertension, diabetes, coronary artery disease, renal failure, etc.).
Authored by: Urdaneta ME, Markson LE, Barrett J, Hamel E, Lapins D
Abstract: Impact of Increased PI Penetration and Correlation with a Decrease in Opportunistic Infection Incidence Rate or HIV Infected Population in a Ryan White Title III Funded Program (Abstract 404)
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