title: Cost of HIV and determinants of health care costs in HIV-positive patients in Germany: results of the DAGNÄ K3A Study.
abstract: OBJECTIVE
  The aims of this study were to estimate the expenditure for HIV-care in Germany and to identify variables associated with resource use.
  
  
  METHODS
  We performed an 18-month prospective multi-center study in an HIV specialized ambulatory care setting from 2006 to 2009.
  
  
  METHODS
  Patients were eligible for study participation if they (1) were HIV-positive, (2) were ≥ 18 years of age, (3) provided written consent and (4) were not enrolled in another clinical study; 518 patients from 17 centers were included.
  
  
  METHODS
  Health care costs were estimated following a micro-costing approach from two perspectives: (1) costs incurred to society in general, and (2) costs incurred to statutory health insurance. Data were obtained using questionnaires. Several empirical models for identifying the relationship between health care costs and independent variables, including age, gender, route of transmission and CD4 cell count at baseline, were developed.
  
  
  RESULTS
  Average annual health care costs were <euro>23,298 per patient from the societal perspective and <euro>19,103 from the statutory health insurance perspective. Most expenses are caused by antiretroviral medication (80 % of the total and 89 % of direct costs), while hospital costs represented 7 % of total expenditure. A statistically significant association was found between health care costs and clinical variables, with higher CD4 count and female gender generating lower costs, while increased antiretroviral experience and injection drug use led to higher expenditures (P < 0.05).
  
  
  CONCLUSIONS
  Expenditures for HIV-infection are driven mainly by drug costs. We identified several clinical variables influencing the costs of HIV-treatment. This information could assist policymakers when allocating limited health care resources to HIV care.
authors.affiliation: Institute for Health Care Management and Research, University of Duisburg-Essen, Schützenbahn 70, 45127, Essen, Germany. sarah.mostardt@medman.uni-due.de
authors.forename: Sarah
authors.initials: S
authors.lastname: Mostardt
authors.forename: Nikola
authors.initials: N
authors.lastname: Hanhoff
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
authors.forename: Armin
authors.initials: A
authors.lastname: Goetzenich
authors.forename: Knud
authors.initials: K
authors.lastname: Schewe
authors.forename: Eva
authors.initials: E
authors.lastname: Wolf
authors.forename: Christoph
authors.initials: C
authors.lastname: Mayr
authors.forename: Hans
authors.initials: H
authors.lastname: Jaeger
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.forename: Stephan
authors.initials: S
authors.lastname: Dupke
authors.forename: Anja
authors.initials: A
authors.lastname: Neumann
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D017281:Cost of Illness; D005260:Female; D005858:Germany; D006679:HIV Seropositivity / Q000188:drug therapy / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011795:Surveys and Questionnaires