November 29, 2010
The higher costs of starting HIV treatment when the disease is well advanced can persist for years, report researchers from Johns Hopkins University.
Among 8,348 study patients in nine HIV clinics around the country, the stage of the disease when treatment began had a dramatic impact on costs. Treatment costs during the first seven or eight years for "late entrants," those who began care when CD4 counts were equal to 200 cells/mm3 or below, were $27,275 to $61,615 higher than for those who entered care with a CD4 count of more than 500.
"We know that it's important clinically to get people into care early because they will stay healthier and do better over the long run," said a statement from Dr. Kelly Gebo, an associate professor of medicine in the division of infectious diseases at Hopkins' School of Medicine. "But now we know it's also more costly to the health care system for potentially decades and a serious drain on our limited health care dollars."
The researchers attributed the additional cost to the challenge of boosting CD4 counts when they have dropped to low levels. In addition, the weakened immune system of someone who has a low CD4 count is more vulnerable to other diseases.
People often delay treatment because they do not know they are infected, because they do not know how to access care or because of other issues such as addiction or mental illness, the researchers said. The patients in the study entered care between 2000 and 2006.
The full study, "The Economic Burden of Late Entry into Medical Care for Patients with HIV Infection," was published in Medical Care (2010;48(12):1071-1079).