Comparing total health care costs and treatment patterns of HIV patients in a managed care setting

• Published in: AIDS care Vol. 16; no. 6; pp. 767 - 780
• Main Authors: Purdum, A. G., Johnson, K. A., Globe, D. R.
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis 01.08.2004; Taylor & Francis Ltd
• Subjects: Acquired Immune Deficiency Syndrome; Adolescent; Adult; AIDS; AIDS/HIV; Antiretroviral Therapy, Highly Active - economics; Biological and medical sciences; California; Comparative analysis; Comparative studies; Costs; Cross-Sectional Studies; Drug Costs; Economics, Pharmaceutical; Female; General populations; Health care; Health Care Costs; Health Care Costs - standards; Health care expenditures; Health expenditure; Health Resources - economics; HIV; HIV Infections - drug therapy; HIV Infections - economics; Hospitalization; Human immunodeficiency virus; Humans; Male; Managed care; Managed Care Programs - economics; Medical sciences; Medical treatment; Middle Aged; Patients; Patterns; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Treatment; USA; United States; North America; America; California; Infection; Human; Immunopathology; Treatment; Financing cost; Managed care; Viral disease; AIDS; Hospitalization; Health service; Immune deficiency; Public health
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540120412331269602

The objective of this study was to investigate total health care costs and time to occurrence of hospitalization in HIV-infected patients treated according to the 1998 DHHS guidelines in a managed care setting. The study also investigated which patients do not receive guideline treatment. We used a retrospective cross-sectional study design using medical and pharmacy claims data. Data from 1,791 HIV-infected patients using antiretroviral agents between 1 February 1998 and 31 July 1999, including demographic characteristics, medication guideline use, medication adherence and cost of care, were examined. Factors associated with total health care costs and time-to-inpatient admission (as a proxy for patient outcomes) were assessed. Patients receiving guideline (HAART) therapy (55%) had higher prescription and total health care costs but lower medical costs. Patients not receiving treatment according to guidelines were more likely to be female, older, have comorbidities, lower medication adherence and no AIDs-defining illness. Treatment with HAART guidelines was associated with longer time-to-inpatient admission controlling for other factors. In a short-term cross-sectional analysis, patients treated with HAART guidelines had better outcomes based on time-to-inpatient admission but higher prescription and total health care costs. Some patients are at risk for not receiving care according to national treatment guidelines and may be targeted for intervention programmes.