HIV treatment costs much more when patients start treatment later in the disease
Patients who begin treatment for HIV infection well after the infection is established have much higher overall treatment costs than patients who begin treatment early in the disease process, concludes a new study. This is important because historically 24-43 percent of patients who enter treatment are found to do so late in the infection. The findings underscore the importance of motivating individuals at risk of HIV infection to seek HIV testing, and of reducing the time between the first positive test for HIV and beginning treatment, suggest the researchers.
John Fleishman, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ), and colleagues in the HIV Research Network estimated direct medical expenditures for 8,348 HIV patients. They categorized patients by the level of CD4 lymphocytes (an indicator of disease progression) when they began treatment. Late entrants to treatment were patients with initial CD4 lymphocyte counts of 200 cells/mm3 or less (indicative of more advanced disease), who accounted for 43 percent of patients enrolled in the study. Early entrants to treatment were patients with initial CD4 counts above 500 cells/mm3.
The study used data from 10 of 14 HIV Research Network clinics on adult patients who began treatment between 2000 and 2006. The study looked at treatment costs through the end of 2007. Men, members of racial or ethnic minorities, and older patients were more likely to enter treatment late. Heterosexual transmission, rather than male-to-male or intravenous drug use transmission, also increased the risk of late entry to care. The difference in mean cumulative treatment expenditures between late and early entrants ranged from $27,275 for patients in care for 1 year, to $61,615 for patients in care for 5 years.
Information on standard inpatient charges came from AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases. The study was funded in part by AHRQ (Contract No. 290-06-0025).
More details are in "The economic burden of late entry into medical care for patients with HIV infection" by Dr. Fleishman, Baligh R. Yehia, M.D., Richard D. Moore, M.D., M.H.Sc., and others in the December 2010 issue of Medical Care 48(12), pp. 1071-1079. Reprints (AHRQ Publication No. 11-R026) are available from the AHRQ Publications Clearinghouse.
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