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

Enns, Benjamina; Krebs, Emanuela; Mathews, William C.b; Moore, Richard D.c; Gebo, Kelly A.c; Nosyk, Bohdana,d for the HIV Research Network

doi: 10.1097/QAD.0000000000002220

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/μl, 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.

aBC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada

bDepartment of Medicine, University of California, San Diego, La Jolla, California

cDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

dFaculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.

Correspondence to Bohdan Nosyk, PhD, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 613–1081 Burrard St., Vancouver, BC, Canada V6Z 1Y6. Tel: +1 604 806 8649; e-mail:

Received 29 November, 2018

Revised 13 March, 2019

Accepted 15 March, 2019

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