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. 2015 Mar;33(3):243-53.
doi: 10.1007/s40273-014-0229-8.

Costs of health resource utilization among HIV-positive individuals in British Columbia, Canada: results from a population-level study

Bohdan Nosyk  1 , Viviane Lima, Guillaume Colley, Benita Yip, Robert S Hogg, Julio S G Montaner
Affiliations

Costs of health resource utilization among HIV-positive individuals in British Columbia, Canada: results from a population-level study

Bohdan Nosyk et al. Pharmacoeconomics. 2015 Mar.

Abstract

Background: Through delayed HIV disease progression, highly active antiretroviral therapy (HAART) may reduce direct medical costs, thus at least partially offsetting therapy costs. Recent findings regarding the secondary preventive benefits of HAART necessitate careful consideration of funding allocations for HIV/AIDS care. Our objective is to estimate non-HAART direct medical costs at different levels of disease progression and over time in British Columbia, Canada.

Methods: We considered the population of individuals with HIV/AIDS within a set of linked disease registries and health administrative databases (N = 11,836) from 1996 to 2010. Costs of hospitalization, physician billing, diagnostic testing and non-HAART medications were calculated in 2010 Canadian dollars. Effects of covariates on quarterly costs were assessed with a two-part model with logit for probability of non-zero costs and a generalized linear model (GLM). Net effects of CD4 strata on direct non-HAART medical costs were evaluated over time during the study period.

Results: Compared with person-quarters in which CD4 >500/mm(3), costs were Can$185 (95 % confidence interval [CI] 132-239) greater for CD4 350-500/mm(3), Can$441 (95 % CI 366-516) greater for CD4 200-350/mm(3) and Can$1,173 (95 % CI 1,051-1,294) greater when CD4 <200/mm(3). Prior to HIV care initiation, individuals incurred costs Can$385 (95 % CI 283-487) greater than in periods with CD4 >500/mm(3). Hospitalization comprised the majority of the increment in costs amongst those with no measured CD4. Evaluated at CD4 state conditional means, those with CD4 <200/mm(3) incurred quarterly costs of Can$5,781 (95 % CI 4,716-6,846) versus Can$1,307 (95 % CI 1,154-1,460; p < 0.001) for CD4 ≥500/mm(3) in 2010.

Conclusion: Non-HAART direct medical costs were substantially lower for individuals during periods of sustained virologic suppression and high CD4 count. HIV treatment and prevention evaluations require detailed health resource use data to inform funding allocation decisions.

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Conflict of interest statement

Conflicts of Interest: Dr. Julio Montaner has received grants from Abbott, Biolytical, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and ViiV Healthcare. He is also is supported by the Ministry of Health Services and the Ministry of Healthy Living and Sport, from the Province of British Columbia; through a Knowledge Translation Award from the Canadian Institutes of Health Research (CIHR); and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse, at the US National Institutes of Health. He has also received support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institute on Drug Abuse, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), Bill & Melinda Gates Foundation, French National Agency for Research on AIDS & Viral Hepatitis (ANRS), Public Health Agency of Canada. All other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Net effect of current CD4 count strata and AUC(pVL) on direct non-HAART medical costs, evaluated at unconditional population-level means AUC(pVL): area under the plasma viral load curve.
Figure 2
Figure 2
Quarterly non-HAART medical costs by CD4 stratum (1996–2010) PANEL A: Evaluated at unconditional population-level mean-valued covariates PANEL B: Evaluated at CD4-stratum and calendar year-specific mean-valued covariates
Figure 2
Figure 2
Quarterly non-HAART medical costs by CD4 stratum (1996–2010) PANEL A: Evaluated at unconditional population-level mean-valued covariates PANEL B: Evaluated at CD4-stratum and calendar year-specific mean-valued covariates
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