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Contemporary costs of HIV healthcare in the HAART era

Gebo, Kelly Aa; Fleishman, John Ab; Conviser, Richardc; Hellinger, Jamesd; Hellinger, Fred Jb; Josephs, Joshua Sa; Keiser, Philipe; Gaist, Paulf; Moore, Richard Da; for the HIV Research Network

doi: 10.1097/QAD.0b013e32833f3c14
Epidemiology and Social

Background: The delivery of HIV healthcare historically has been expensive. The most recent national data regarding HIV healthcare costs were from 1996–1998. We provide updated estimates of expenditures for HIV management.

Methods: We performed a cross-sectional review of medical records at 10 sites in the HIV Research Network, a consortium of high-volume HIV care providers across the United States. We assessed inpatient days, outpatient visits, and prescribed antiretroviral and opportunistic illness prophylaxis medications for 14 691 adult HIV-infected patients in primary HIV care in 2006. We estimated total care expenditures, stratified by the median CD4 cell count obtained in 2006 (≤50, 51–200, 201–350, 351–500, >500 cells/μl). Per-unit costs of care were based on Healthcare Cost and Utilization Project (HCUP) data for inpatient care, discounted average wholesale prices for medications, and Medicare physician fees for outpatient care.

Results: Averaging over all CD4 strata, the mean annual total expenditures per person for HIV care in 2006 in three sites was US $19 912, with an interquartile range from US $11 045 to 22 626. Average annual per-person expenditures for care were greatest for those with CD4 cell counts 50 cell/μl or less (US $40 678) and lowest for those with CD4 cell counts more than 500 cells/μl (US $16 614). The majority of costs were attributable to medications, except for those with CD4 cell counts 50 cells/μl or less, for whom inpatient costs were highest.

Conclusion: HIV healthcare in the United States continues to be expensive, with the majority of expenditures attributable to medications. With improved HIV survival, costs may increase and should be monitored in the future.

aDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

bAgency for Healthcare Research and Quality, Rockville, Maryland, USA

cGlobal Health Policy Partners, Missoula, Montana, USA

dCommunity Medical Alliance, Boston, Massachusetts, USA

eUniversity of Texas, Southwestern, Galveston, Texas, USA

fNational Institutes of Health, Bethesda, Maryland, USA.

Received 8 January, 2010

Revised 26 July, 2010

Accepted 6 August, 2010

Correspondence to Dr Kelly A. Gebo, Johns Hopkins University School of Medicine, 1830 E. Monument St, Room 435, Baltimore, MD 21287, USA. Tel: +1 410 502 2325; fax: +1 410 955 7889; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.