Study shows HAART reduced inpatient costs
Study shows HAART reduced inpatient costs
Women, minorities, poor still have high costs
A nationwide study presents a clear picture of how highly active antiretroviral therapy (HAART) has reduced inpatient hospital costs for HIV patients. But the benefits of antiretroviral therapy are less pronounced among women, minorities, and poor people infected with HIV.1
"We see a pattern very clearly where people who don’t have excellent access don’t experience that shift in costs [from the hospital to medications]," says Samuel A. Bozzette, MD, PhD, senior scientist with RAND Health in Santa Monica, CA, and a professor of medicine at the University of California, San Diego. Bozzette also is the director of Health Services Research Unit at the Veterans Administration Hospital in San Diego.
"Traditionally underserved groups — women, poor, minorities — display the old pattern where hospital costs still remain the largest component of costs," Bozzette explains. "So the second point is that we know the drugs didn’t diffuse through the population equally."
The HIV Cost and Services Utilization Study, sponsored by the federal Agency for Healthcare Research and Quality (AHRQ) of Rockville, MD, was conducted by a consortium led by RAND Health. The study, published this year in the New England Journal of Medicine, determined the mean expenditure per patient per month from 1996 to 1998. Its chief conclusion was that the total cost of care for HIV-infected adults has declined since the advent of HAART, even though the cost of medications has risen.
Another important finding of the research is that the care provided by more experienced clinicians was less expensive, Bozzette notes. The study found that physicians who saw the most HIV/AIDS patients per month had a lower monthly cost of care, and this was unrelated to disease severity.
This study differs from earlier cost studies of HIV treatment in that it studies a nationwide population and thus is more representative. "The study is a nationally selected random study, and these are the closest we have to unbiased estimates," Bozzette says. "There have been a number of studies looking at costs in selected populations," he adds. "Some find declines in overall costs and some slight increases, but all find a decline in hospital use and increases in drug use."
Cost ratios shift over the years
The year 1996 represented the period of change in HIV treatment from pre-protease inhibitors to post-protease inhibitors, says Fred Hellinger, PhD, a senior economist with AHRQ. "What we found in the early 1990s to the late 1990s was a dramatic decrease in hospital costs and a subsequent increase in drug costs," Hellinger says. "Drug costs in the early 1990s were 10% of total costs, but now drugs are above 40% because the antiretroviral drug cocktail costs $10,000 to $15,000 per year."
Future cost studies will tell a very different story because people on HAART are living very long with the disease, Hellinger says. "People are living longer with HIV disease, and rates of infection aren’t changing," Hellinger explains. "That is going to have a dramatic impact on the total cost of the disease as we continue." Early hopes that HAART would reduce HIV to a level where it couldn’t replicate were dashed, so it appears that HIV patients will have to stay on antiretroviral drugs indefinitely, which will increase costs, Hellinger adds.
The cost study points to the need for clinicians to make certain that all HIV patients receive necessary treatment, and they should be especially attentive to people who traditionally have less access to health care services. "It seems the major issue is not what happens to people once they get into a clinic," Bozzette says. "The major issue is getting people to see experienced and knowledgeable AIDS providers so patients don’t present for care when they are sick enough to be hospitalized."
Reference
1. Bozzette SA, Joyce G, McCaffrey DF, et al. Expenditures for the care of HIV-infected patients in the era of highly active antiretroviral therapy. N Engl J Med 2001; 344:817-823.
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