A nationwide study sponsored by the federal Agency for Healthcare Research and Quality (AHRQ), has found that expenditures for hospital inpatient care for HIV fell more than 40 percent by mid-1997 in the wake of the introduction early the preceding year of highly active combination antiretroviral therapy, a mixture of protease inhibitors and other drugs. The decrease in demand for hospital care, along with a more modest reduction in the use of outpatient care, helped drive down overall treatment expenditures for HIV patients by one-sixth between early 1996 and late 1998.
According to the HIV Cost and Services Utilization Study (HCSUS), which was conducted by a consortium led by RAND Health, the mean monthly expenditures per HIV patient, which included expenses for hospital and outpatient care, as well as for drug therapy, declined from $1,792 in 1996 to $1,359 roughly a year later, and then rose slightly to $1,410 by the end of the study period. Findings adjusted for illness severity, patient deaths and other factors show that the average annual per patient expenditure declined from $20,300 to $18,300 during the same period.
Overall expenditures for HIV care declined in all patient groups, but not all HIV patients saw a shift from hospital to outpatient care. By late 1998, hospital care remained the largest treatment cost item for members of under-served groups, accounting for up to half of all spending for HIV care of women, African-Americans, and patients in the eastern part of the United States, as well as HIV patients whose care was paid for by the Medicaid program. In contrast, 75 to 90 percent of the money spent for treating other HIV patients went toward outpatient drug therapy and clinic visits.
"This is a good news-bad news study," said AHRQ Director John M. Eisenberg, M.D. "The good news is that highly active combination antiretroviral therapy reduced the need for expensive hospital inpatient care among HIV patients as a whole; the bad news is that it didn't affect disadvantaged patient groups to the same degree." Dr. Eisenberg added that AHRQ recently launched a $45 million program to examine the causes of disparities in health care and seek solutions.
"Another concern is that demand for inpatient care may be on the rebound for all HIV patient groups," said the HCSUS co-principal investigator and lead author of the study, Samuel A. Bozzette, M.D., Ph.D., a senior scientist with RAND and professor of medicine at the University of California, San Diego. Dr. Bozzette, who also heads the health services research unit of the Veterans Administration Hospital in San Diego, said this is suggested by recent reports of treatment failures involving highly active combination retroviral therapy and by the study's finding that expenditures for the hospital care of HIV patients appeared to be rising by the end of 1998. The research project, which was also supported by the Health Resources and Services Administration and other components of the U.S. Department of Health and Human Services, periodically interviewed a randomly selected sample initially consisting of 2,864 adult HIV patients. For more details, see "Expenditures for HIV Care in the Era of Highly Active Therapy: Results from the HIV Cost and Services Utilization Study," in the March 15, 2001, issue of The NewEngland Journal of Medicine.