Costs of care for HIV infection in a managed care population from 1995 to 1997.
OBJECTIVE
To determine costs of drug and nondrug treatment of HIV-infected patients during introduction of protease inhibitors and combination therapy.


METHODS
Longitudinal, observational study of insurance claims data.


METHODS
Data from managed care organizations in Texas and California contracting with an HIV case management group were reviewed for all non-Medicaid/non-MediCal adults infected with HIV for costs of drugs and nondrug treatment per HIV-infected member per month from January 1995 to December 1997. Costs of care for patients with and without undetectable viral loads (< 400 copies/mL) were quantified.


RESULTS
Per HIV-infected member, average monthly drug costs increased, nondrug costs decreased, and total costs remained stable. Quarterly mortality rates decreased from 4.8% to 0.25%. From the first quarter of 1996 to the last quarter of 1997, the proportion of patients with undetectable viral loads increased from 6% to 56%. Increasing drug costs and decreasing nondrug costs were observed in patients with and without undetectable viral loads, but costs were higher for the latter: after the second quarter of 1996, drug costs were $67 to $277 higher for patients without undetectable viral loads, nondrug costs were $185 to $741 higher, and total costs were $333 to $808 higher.


CONCLUSIONS
Reduced mortality rates and increased viral suppression to undetectable levels were observed during introduction of protease inhibitors and combination therapy in this MCO setting. Increased average monthly drug costs per HIV-infected patient were offset by decreased average monthly nondrug costs, and both costs were lower when patients achieved undetectable viral loads.
Lapins
D L
DL
Outcomes Research and Management, Merck & Co Inc, West Point, PA, USA. dlapins@cp.com
Urdaneta
M E
ME
Barrett
J
J
Hamel
E C
EC
Duong
P T
PT
Markson
L E
LE
D002140:California / Q000453:epidemiology; D017281:Cost of Illness; D016527:Drug Costs / Q000639:trends; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008329:Managed Care Programs / Q000191:economics*; D011480:Protease Inhibitors / Q000191:economics / Q000627:therapeutic use; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load
D011480:Protease Inhibitors