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Even with the high cost of medications prescribed as part of highly active antiretroviral therapy (HAART), it’s cheaper to treat HIV-infected patients and keep them from developing AIDS than it is to take care of them once they have the full-fledged disease, new research shows. "It’s more costly to treat a patient who has AIDS than to treat a patient with HIV medications," states Judith O’Brien, RN, senior researcher and vice president of Caro Research in Concord, MA. Caro Research is an independent health care consulting firm.
"The biggest point to be made is there is always the issue of HAART being very expensive, and while that may be a valid point, you have to look at it in the whole context of treating HIV patients and preventing them from crossing the threshold to AIDS," O’Brien says. "And looking at the broader picture, you get a better sense of how even though one’s therapy may be thought of as costly, in the long run it’s probably more cost-effective in treating patients." O’Brien’s research, presented at the fall Interscience Conference on Antimicrobial Agents and Chemotherapy meeting held in Toronto, examined hospital admissions for AIDS in Massachusetts both before and after antiretroviral therapy came into widespread use.
The findings were as follows:
• Of 13,100 hospital discharges of HIV patients who had not advanced to AIDS and 49,000 patients with AIDS, there was an average annual cost of $17,600 per patient who had HIV without AIDS vs. an annual cost of $24,900 for patients with AIDS. The cost difference per patient was $7,300.
• Patients with AIDS who are hospitalized have an average of 1.8 admissions per year and mean annual hospital costs of $13,277 in 1998 dollars, excluding physician costs.
• The number of reported AIDS cases in Massachusetts rose by 78% between 1995 and 1998 . But the rate of hospitalization declined in the same period from 85% to 31%.
• The cost of inpatient care declined from $8,100 for an average hospital stay for AIDS care in 1995 to a mean of $7,500 in 1998. These costs included medications taken during the hospital stay.
• The average length of stay for AIDS patients fell by 1.3 days between 1995 and 1998.
• The inpatient case fatality rate dropped from 6.7% to 4.6% during that period.
• There was no apparent cost-shifting to postacute settings among this population. The referral rate to post-discharge services dropped by 8.6% between 1995 and 1998.