Neuropsychiatric disorders in HIV infection: impact of diagnosis on economic costs of care.
BACKGROUND
HAART is associated with a growing prevalence of HIV-associated neuropsychiatric disorders (NPD) despite improved overall survival.


OBJECTIVE
To investigate the added direct costs of medical care for patients with and without NPD.


METHODS
Nine dimensions of patient-specific costs [as costs per patient per month (CPM)] were followed prospectively between 1997 and 2003 in a community-based HIV/AIDS clinic for HIV-1-seropositive patients with a diagnosis of NPD (n = 188) and without (n = 153). Patients with NPD were stratified into subgroups of cognitive impairment (CI), peripheral neuropathies (PN), or other neuropsychiatric disorders (OND).


RESULTS
Compared with the non-NPD group ($916), patients in the NPD group showed an increased mean CPM during the 12-month intervals immediately preceding and subsequently following NPD diagnosis [$1371 (P < 0.001) and 1463 US dollars (P < 0.001), respectively], but not at 18 months prior to diagnosis (1061 US dollars; P > 0.05). Intragroup comparisons between 12 month post-diagnosis and 18 month pre-diagnosis showed a mean CPM increased of 67% (1613 US dollars; P < 0.001) with CI, 31% (1490 US dollars; P < 0.01) with PN, and 33% (1362 US dollars; P < 0.01) with OND. Increased numbers of clinic and physician visits, non-antiretroviral drugs and home care accounted for the higher mean CPM (P < 0.05) both pre-and post-diagnosis within the NPD group.


CONCLUSIONS
Neuropsychiatric disorders in patients with HIV/AIDS increase medical costs both before and after diagnosis, primarily owing to the management of the neuropsychiatric illness. Cost analyses offer useful measures of evolving patient needs, and provide a basis for allocation of healthcare resources.
Yeung
Helen
H
Department of Psychiatry, University of Calgary, Calgary, Canada.
Krentz
Hartmut B
HB
Gill
M John
MJ
Power
Christopher
C
D000328:Adult; D000416:Alberta; D023241:Antiretroviral Therapy, Highly Active; D003072:Cognition Disorders / Q000191:economics / Q000628:therapy / Q000821:virology*; D003153:Community Health Services / Q000191:economics; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000523:psychology* / Q000628:therapy; D015497:HIV-1; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000191:economics / Q000628:therapy / Q000821:virology*; D011446:Prospective Studies