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Heterogeneity in the costs of medical care among people living with HIV/AIDS in the United States.

ABSTRACT: OBJECTIVE:The costs of medical care for people with HIV/AIDS (PWH) vary substantially across demographic groups, stages of disease progression and regionally across the United States. We aimed to estimate medical costs for PWH and examine the heterogeneity in costs within key patient groups typically distinguished in cost-effectiveness analyses. DESIGN:Retrospective cohort study using health administrative databases for diagnosed PWH in care at 17 HIV Research Network sites across the United States. METHODS:We estimated mean quarterly costs for key patient groups using multivariable generalized linear mixed effects models. We used quantile regression to highlight differences in the effect of covariates within each patient group (difference between covariate estimates at the mean versus the 90th percentile of quarterly costs), identifying covariates with a larger effect among the highest cost PWH, or generating greater uncertainty in mean cost estimates. RESULTS:Our sample included 40?022 patients with a median age of 39 years. Mean quarterly costs were highest for people who inject drugs with advanced disease progression and for PWH on antiretroviral treatment (ART). Within patient groups, we found the most heterogeneity at different levels of resource use for PWH on ART and PWH off ART with CD4 cell counts less than 200?cells/?l, people who inject drugs, as well as PWH in the South. CONCLUSION:The study quantifies heterogeneity in costs both across and within key PWH patient groups. Our results highlight the need for sensitivity analysis on cost estimates and may inform decisions on model structure in cost-effectiveness analyses on HIV/AIDS treatment and prevention strategies.

SUBMITTER: Enns B

PROVIDER: S-EPMC6602862 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Heterogeneity in the costs of medical care among people living with HIV/AIDS in the United States.

Enns Benjamin B Krebs Emanuel E Mathews William C WC Moore Richard D RD Gebo Kelly A KA Nosyk Bohdan B

AIDS (London, England) 20190701 9

<h4>Objective</h4>The costs of medical care for people with HIV/AIDS (PWH) vary substantially across demographic groups, stages of disease progression and regionally across the United States. We aimed to estimate medical costs for PWH and examine the heterogeneity in costs within key patient groups typically distinguished in cost-effectiveness analyses.<h4>Design</h4>Retrospective cohort study using health administrative databases for diagnosed PWH in care at 17 HIV Research Network sites across ...[more]

PMID: 30950881

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Project description:Background and objectiveThere is an increase in the global prevalence of the human immunodeficiency virus (HIV). While it has been proven that pharmacist interventions improve the health outcomes of people living with HIV/AIDS (PLWHA), the economic impact of these initiatives is uncertain. Consequently, we aim to systematically review and synthesize the evidence surrounding the economic impact of pharmacist care in PLWHA.MethodsPubMed, EMBASE, Scopus, IPA via ProQuest, the Cochrane Library, and the CINAHL Plus databases were systematically searched. Original studies evaluating the economic effect of pharmacist-managed services for PLWHA were included in the review. The quality of the economic studies was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) checklist.ResultsA search of databases yielded 4206 citations, four of which met the eligibility criteria. Three studies were conducted in a hospital-based outpatient facility, while one study was conducted in a community pharmacy setting. The types of "pharmacist-managed services" included targeted motivational education, pharmaceutical care, health screening for opportunistic infections, and referral to specialists. Two of the four economic evaluation studies had complete economic analyses and were rated as moderate in quality. In comparison with usual care, pharmacist services led to cost savings of (51.29 to 165.74 in 2021 USD$) per person per year, saving 18.5 h per patient per year, and a lower cost of generating 12 years of quality-adjusted life years. In addition, the benefit-to-cost ratio of the pharmacist service was 2.51:1.ConclusionsThe pharmacist-managed services demonstrated the benefits of improving overall PLWHA health outcomes in economic viability. However, future real world controlled, high-quality economic studies are required to determine the long-term cost-effectiveness of these services, given the pharmacist's growing role in the health care team managing PLWHA.

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Dataset Information

Heterogeneity in the costs of medical care among people living with HIV/AIDS in the United States.

Publications

Heterogeneity in the costs of medical care among people living with HIV/AIDS in the United States.

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