The Direct Medical Costs of Late Presentation (<350/mm) of HIV Infection over a 15-Year Period

Abstract

We describe the immediate- and longer-term direct medical costs of care for individuals diagnosed with HIV at CD4 counts <350/mm(3) ("late presenters"). We collected and stratified by initial CD4 count all inpatient, outpatient, and drug costs for all newly diagnosed patients accessing HIV care within Southern Alberta from 1/1/1995 to 1/1/2010. 59% of new patients were late presenters. We found significantly higher costs for late presenters, especially inpatient costs, during the first year after accessing care. Direct medical costs remained almost twice as high for late presenters in subsequent years compared to patients presenting with CD4 counts >350/mm(3) despite significantly their improved CD4 counts. The sustained high cost for late presenters has implications for recent recommendations for wider routine HIV testing and the earlier initiation of cART. Earlier diagnosis and treatment, while increasing the immediate expenditures within a population, may produce both direct and indirect cost savings in the longer term.

Figure 1

Proportions of newly diagnosed HIV patients accessing care with CD4 counts <200/mm³ (“advanced disease”) and/or <350/mm³ (“late presenters”).

Figure 2

(a) Proportional costs of direct medical care with for newly diagnosed HIV patients accessing care from 1995 to 2010, (b) catergorized by cost category.

Figure 3

Proportions of the total direct medical costs incurred by “late presenters” (<350/mm³) as a percentage of all direct medical costs for newly diagnosed HIV patients accessing care.

Figure 4

Mean cumulative PPPM (per patient per month) total cost of care for HIV patients accessing care in the year listed and followed until the patient moved, died, or 12/31/2009 in 2009 Cdn$.