Current medical research and opinion 2017 09 21() 1-15 doi 10.1080/03007995.2017.1383889
To estimate the incremental healthcare utilization and costs associated with common non-infectious comorbid conditions among commercially and Medicaid-insured HIV-infected patients in the US.
US administrative claims were used to select adult HIV patients with chronic kidney disease (CKD), cardiovascular disease (CVD) events, or fracture/osteoporosis, three common comorbidities that have been associated with HIV and HIV treatment, between 01/012004 and 06/30/2013. Propensity score matched controls with no CKD, no CVD events, no fracture/osteoporosis were identified for comparison. All-cause healthcare utilization and costs were reported as per patient per month (PPPM).
The commercial comprised 381 CKD patients, 624 patients with CVD events, and 774 fracture/osteoporosis patients; and 1,013, 1,710, and 2,081 matched controls, respectively, while the Medicaid HIV cohort comprised 207 CKD and 271 CVD cases, and 516 and 735 matched controls, respectively. There were insufficient Medicaid data for fracture analyses. Across both payers, HIV patients with CKD or CVD events had significantly higher healthcare utilization and costs than controls. The average incremental PPPM costs in HIV patients with CKD were $1,403 in commercial and $3,051 in Medicaid. In those with CVD events, the incremental costs were $2,655 (commercial) and $4,959 (Medicaid) for HIV patients compared to controls (p < 0.001). CONCLUSIONS
Results suggested a considerable increase in healthcare utilization and costs associated with CKD, CVD and fracture/osteoporosis comorbidities among HIV patients in the past decade. Because these conditions have been associated with treatment, it is critical to consider their impact on the costs and outcomes when optimizing patient care.