Hospital and community care costs for people newly diagnosed of living with HIV in London, UK

ABSTRACT

This study of people newly diagnosed of living with HIV (ND-PLHIV) calculated the use, cost and outcome of HIV services at a London HIV centre. ND-PLHIV were followed July 2017-October 2018. Hospital data included inpatient days (IP), outpatient (OP), dayward (DW) visits, tests and procedures, and anti-retroviral drugs (ARVs). Community services were recorded in daily diaries. Mean per patient-year (MPPY) use was multiplied by unit costs. 13.6 MPPY (95%CI 12.4–14.9) OP visits, 0.4 MPPY (95%CI 0.1–0.7) IP days, 0.09 MPPY (95%CI 0.01–0.2) DW visits and 4.6 MPPY community services (95%CI 3.4–5.8). Total annual costs per patient-year (CPPY) was £11,483 (95%CI £10,369–12,597): ARVs comprised 63% and community services 2%. White participants used fewer hospital and more community services compared with minority ethnic community (MEC) participants. Costs for White ND-PLHIV was £10,778 CPPY (95%CI £9629–11,928); £13,214 (95%CI £10,656–15,772) for MEC ND-PLHIV (p < 0.06). Annual costs were inversely related to CD4 count at entry (r = −5.58, p = 0.02); mean CD4 count was 476 cells/mm³ (95%CI 422–531) versus 373 cells/mm³ (95%CI 320–425) for White and MEC participants respectively (p = 0.03). Annual costs for ND-PLHIV with CD4 ≤ 350 cells/mm³ was £2478 PPY higher compared with CD4 count >350 cells/mm³ (p = 0.04).

KEYWORDS:

• Newly diagnosed PLHIV
• access
• use & cost hospital and community services
• English populations
• cost versus expenditure analyses

Acknowledgements

The authors thank all the participants that took part in this study and the staff that provided support or information, that made the study possible. We also thank the reviewers’ comments that improved the clarity of the paper. The study protocol and amendments were reviewed and approved by the National Research Ethics Service -NRES Committee London-Surrey Borders. JF, EJB, SM developed the conceptual framework for the study. AS, NP, JL, JF recruited, followed up the study participants and collected the data for the study. SM, DL, EJB, JF led and performed the analyses. EJB, SM, JF, DL, AS, NP, JL were involved with writing up, reviewed all drafts of the paper and all authors have read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was financially supported through a non-restrictive grant from Gilead, with no influence on the independence of the researchers and its editorial policy. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript and there are no patents, products in development or marketed products to declare. This was supported by Guy’s and St Thomas’ NHS Foundation Trust [grant number EVL_IN-UK-164-2014].