Healthcare utilization and direct costs of non-infectious comorbidities in HIV-infected patients in the USA

Abstract

Objective: 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.

Methods: 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 1 January 2004 and 30 June 2013. Propensity score matched controls with no CKD, no CVD events, and no fracture/osteoporosis were identified for comparison. All-cause healthcare utilization and costs were reported as per patient per month (PPPM).

Results: The commercial cohort comprised 381 CKD patients, 624 patients with CVD events, and 774 fracture/osteoporosis patients, and 1013, 1710, and 2081 matched controls, respectively; while the Medicaid HIV cohort comprised 207 CKD and 271 CVD cases, and 516 and 735 matched controls, respectively. There was 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 $1403 in the commercial cohort and $3051 in the Medicaid cohort. In those with CVD events, the incremental costs were $2655 (commercial) and $4959 (Medicaid) for HIV patients compared to controls (p < .001).

Conclusions: The 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 costs and outcomes when optimizing patient care.

Keywords:

• Healthcare costs
• HIV
• claims data
• chronic kidney disease
• cardiovascular disease

Transparency

Declaration of funding

The study was supported by Gilead Sciences Inc.

Author contributions: P.H., J.G., D.B. and N.M. contributed to conception and design; D.B. and N.M. to analysis of data; P.H., J.G., D.B. and N.M. to interpretation of the data; P.H., J.G., D.B. and N.M. to drafting, review of critical intellectual content and revisions of manuscript.

Declaration of financial/other relationships

J.G. has disclosed that he has received research funding from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Merck & Co, Sangamo BioSciences and ViiV Healthcare/GlaxoSmithKline, and has received consulting fees from Bristol-Myers Squibb, Gilead Sciences, Merck & Co., Theratechnologies, ViiV Healthcare/GlaxoSmithKline. P.H. has disclosed that she has received research funding from Gilead Sciences and Pfizer, and has been a consultant for Bristol-Myers Squibb, Gilead Sciences, Janssen Therapeutics, Merck & Co., and ViiV Healthcare. D.B. has disclosed that he is an employee and shareholder of Gilead Sciences. N.M. has disclosed that she is an employee of Truven Health Analytics, an IBM company.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgements

We thank Laurie Costa for her support in building the study database and analyzing the data, and Kavya Thelakkat for her manuscript editing.