The economic burden of late entry into medical care for patients with HIV infection.
BACKGROUND
A large proportion of people with human immunodeficiency virus (HIV) infection enter care late in the HIV disease course. Late entry can increase expenditures for care.


OBJECTIVE
To estimate direct medical care expenditures for HIV patients as a function of disease status at initial presentation to care. Late entry is defined as initial CD4 test result ≤ 200 cells/mm3, intermediate entry as initial CD4 counts >200, and ≤ 500 cells/mm3; and early entry as initial CD4 count >500.


METHODS
The study included 8348 patients who received HIV primary care and who were newly enrolled between 2000 and 2006 at one of 10 HIV clinics participating in the HIV Research Network.


METHODS
We reviewed medical record data from 2000 to 2007. We estimated costs per outpatient visit and inpatient day, and monthly medication costs (antiretroviral and opportunistic illness prophylaxis). We multiplied unit costs by utilization measures to estimate expenditures for inpatient days, outpatient visits, HIV medications, and laboratory tests. We analyzed the association between cumulative expenditures and initial CD4 count, stratified by years in care.


RESULTS
Late entrants comprised 43.1% of new patients. The number of years receiving care after enrollment did not differ significantly across initial CD4 groups. Mean cumulative treatment expenditures ranged from $27,275 to $61,615 higher for late than early presenters. After 7 to 8 years in care, the difference was still substantial.


CONCLUSIONS
Patients who enter medical care late in their HIV disease have substantially higher direct medical treatment expenditures than those who enter at earlier stages. Successful efforts to link patients with medical care earlier in the disease course may yield cost savings.
Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA. john.fleishman@ahrq.hhs.gov
John A
JA
Fleishman
Baligh R
BR
Yehia
Richard D
RD
Moore
Kelly A
KA
Gebo
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D003153:Community Health Services / Q000191:economics; D017281:Cost of Illness; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000628:therapy; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D019380:Anti-HIV Agents