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Previous Volume 344:817-823 March 15, 2001 Number 11 Next

	Full Text PDF Editorial by Steinbrook, R. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The introduction of expensive but very effective antiviral medications has led to questions about the effects on the total use of resources for the care of patients with human immunodeficiency virus (HIV) infection. We examined expenditures for the care of HIV-infected patients since the introduction of highly active antiretroviral therapy.

Methods We interviewed a random sample of 2864 patients who were representative of all American adults receiving care for HIV infection in early 1996, and followed them for up to 36 months. We estimated the average expenditure per patient per month on the basis of self-reported information about care received.

Results The mean expenditure was $1,792 per patient per month at base line, but it declined to $1,359 for survivors in 1997, since the increases in pharmaceutical expenditures were smaller than the reductions in hospital costs. Use of highly active antiretroviral therapy was independently associated with a reduction in expenditures. After adjustments for the interview date, clinical status, and deaths, the estimated annual expenditure declined from $20,300 per patient in 1996 to $18,300 in 1998. Expenditures among subgroups of patients varied by a factor of as much as three. Pharmaceutical costs were lowest and hospital costs highest among underserved groups, including blacks, women, and patients without private insurance.

Conclusions The total cost of care for adults with HIV infection has declined since the introduction of highly active antiretroviral therapy. Expenditures have increased for medications but have declined for other services. However, there are large variations in expenditures across subgroups of patients.

Source Information

From RAND Health, Santa Monica (S.A.B., G.J., D.F.M., A.A.L., S.C.M., S.H.B., A.R., M.F.S., D.P.G.); the University of California, San Diego (S.A.B., D.T.); the University of California, Los Angeles (A.A.L., M.F.S.); and the Veterans Affairs San Diego Healthcare System (S.A.B., D.T.) — all in California.

Address reprint requests to Dr. Bozzette at RAND, 1700 Main St., Santa Monica, CA 90407-2318, or at sbozzette{at}ucsd.edu.

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