title: The epidemiology, treatment patterns, and costs of cytomegalovirus retinitis in the post-haart era among a national managed-care population.
abstract: To examine the epidemiology, treatment patterns, and costs of cytomegalovirus (CMV) retinitis treatment in the post-HAART (highly active antiretroviral therapy) era, a retrospective cohort study was performed using data from US managed-care plans from 1997-2002. Cases with CMV retinitis were defined by requiring diagnosis codes for HIV (or AIDS), CMV, and retinitis and claims for anti-CMV treatment. Costs of oral, intravenous, and intraocular treatment periods were examined. The incidence of enrolled HIV or AIDS cases increased from 7 per million members in 1997 to 150 per million members in 2001. The incidence of CMV retinitis decreased from 23 per 10,000 HIV or AIDS cases in 1997 to 8 per 10,000 HIV or AIDS cases in 2001. The average duration of a CMV episode was 192 days and the average cost was 19,576 US dollars. In a multiple linear regression model adjusting for age, gender, insurance type, geographic region, HAART use, and co-existing AIDS-defining illnesses, intraocular and oral treatment periods saved 7135 and US dollars and 6866 US dollars, respectively, per treatment period compared with intravenous treatment (P < 0.05). The incidence of CMV retinitis decreased in this managed-care population during the post-HAART era. Use of oral or intraocular treatment saves costs compared with intravenous treatment in a managed-care environment.
authors.affiliation: MEDTAP International, Inc., Bethesda, MD 20814, USA. mahadevia@medtap.com
authors.forename: Parthiv J
authors.initials: PJ
authors.lastname: Mahadevia
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
authors.forename: Krista
authors.initials: K
authors.lastname: Pettit
authors.forename: J P
authors.initials: JP
authors.lastname: Dunn
authors.forename: Melva T
authors.initials: MT
authors.lastname: Covington
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D000284:Administration, Oral; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007267:Injections / Q000191:economics / Q000379:methods; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents