Posted on July 10, 2002 at 8:40 a.m.
BIRMINGHAM, AL — The first comprehensive cost analysis of HIV patient care in the era of effective therapy in the United States reveals an average cost difference of more than $20,000 a year to treat patients with advanced-stage disease versus well patients with HIV. “We knew it cost more to care for sicker patients,” says Dr. Michael Saag, director of the 1917 Clinic at the University of Alabama at Birmingham (UAB). “This analysis shows how much more, what factors account for the difference and the cost benefit of therapy.” Saag will present details of findings during a plenary session of the XIV International AIDS Conference in Barcelona on Wednesday.
The study examined annual healthcare costs of nearly 700 clinic patients over a two-year period. “We figured expenses based on actual patient encounters with the health care system and assigned current Medicare reimbursement rates. Medication costs were based on average wholesale price (AWP),” says Saag. “We found the average annual cost of patient care for those with advanced-stage disease, or those with CD4 cell counts of less than 50, is about $34,000, and for well patients with HIV, or those with CD4 cell counts of more than 350, the cost is about $14,000.”
Non-HIV medications used to treat infections associated with advanced HIV disease, such as pneumonia, TB and certain types of cancers, account for about $12,000, or about 60 percent, of the cost difference. “Regardless of the stage of disease, the majority of cost is in the medications, from about $11,000 for well patients to about $24,000 for sicker patients,” says Saag. “The greatest single variable is non-HIV medications, ranging from $1,800 to $14,000 a year.”
Hospitalization is the second largest expense incurred by patients with advanced-stage HIV and accounts for about $6,000, or 30 percent, of the cost difference. “Hospital costs drop dramatically from an average of $7,800 to $1,700 a year as a patient’s condition improves,” says Saag. “There is a direct correlation between patients getting better as a result of antiretroviral medications and the overall costs going down.”
Of the five cost components measured — HIV medications, non-HIV medications, hospitalization, clinic costs and diagnostic costs (lab tests, procedures, and imaging) — clinic costs accounted for less than 2 percent of the average cost of care for all patients. “Clinics receive on average about $340 per patient per year,” says Saag. “That is what we use to pay salaries for physicians and nurses and for record-keeping, home health care supervision, social services, outreach activities, and rent. We’re taking a big hit in reimbursement costs."
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