Abstract
Background: Highly active antiretroviral therapy (HAART) or combination antiretroviral (ARV) therapy is associated with reduced morbidity and mortality. Yet, many HIV-infected patients endure incomplete HIV suppression from HAART or combination ARV therapy, increasing cost and limiting effectiveness. Little is known about the direct healthcare costs of HIV+ patients requiring multiple HAART regimen switches because of incomplete HIV suppression. In an HMO-based population of HIV+ patients, we examined resource and cost implications of multiple relative to single (or no) HAART switches starting from first HAART regimen.
Methods: Retrospective analysis of HIV+ patients of the Northern California and Northwest regions of Kaiser Permanente during 2004. Continuous active 12-month membership and minimum 12 months of continuous HAART. Cases on third or later HAART regimen; controls on 1st or 2nd regimen. Regimen switch is combination change of two or more additions of ARV drugs to an existing HAART regimen. Cost categories drugs, outpatient, inpatient, lab, and radiology. Patients followed from first HAART regimen to death, disenrollment, or end of study up to 60 months.
Results: 287 cases (19% female); 1,645 controls (12% female) followed from 1st regimen. Mean total per-patient follow-up costs were $105,132 (cases) vs. $70,004 (controls). Mean pharmacy costs were $70,672 (cases) vs. $49,668 (controls) (P <.04). Of cases mean pharmacy costs, 85% were antiretroviral-based (90% for controls). Mean dispenses of both ARV and non-ARV drugs were higher for cases (80 vs. 60 for antiretrovirals, 64 vs. 60 for non-antiretrovirals). Mean outpatient costs were $13,100 (cases) vs. $8,952 (controls) (P<.0001). Mean ER and mean non-specialty visits were both higher among cases (P <.03). Fourteen percent of cases had at least one inpatient stay vs. 10% of controls. Inpatient costs per patient with at least one stay were $101,396 (cases) vs. $72,000 (controls) (not significant). Mean radiology costs were $1,412 (cases) vs. $956 (controls) (P=.05); mean lab costs were $4,728 (cases) vs. $3,472 (controls) (P<.0001).
Conclusions: HIV-infected patients on a third or later HAART regimen incurred costs in total and across most categories that greatly exceeded costs of similar patients on earlier regimens. Working to ensure success with initial HAART regimens appears to lower total cost of HIV care.
