The Association Of HIV With Health Care Spending And Use Among Medicare Beneficiaries

Abstract

An increasingly older population of people with HIV raises concerns about how HIV may influence care for Medicare patients. We therefore sought to determine the extent to which HIV influences additional spending on and use of mental health and medical care among Medicare beneficiaries and, importantly, whether treatment with antiretroviral therapy may reduce this additional spending. Using 2016 Medicare claims, we compared risk-adjusted spending and utilization for Medicare beneficiaries with and without HIV, as well as subgroups of people receiving antiretroviral therapy (ART). Compared to beneficiaries without HIV, those with HIV receiving ART incurred 220.6 percent more spending, mostly driven by ART spending, whereas those with HIV not receiving ART incurred 95.4 percent more spending. Among beneficiaries with HIV, those receiving more months of ART had lower spending on treatment for other chronic conditions relative to those receiving fewer months of ART in a dose-response manner. Beneficiaries with HIV not receiving ART incurred the highest spending related to infections, mental health disorders, and other medical conditions compared to beneficiaries in other HIV subgroups receiving ART for various numbers of months. Our findings suggest that ART may be associated with Medicare Parts A and B savings, but ART adherence and the high prices of HIV drugs in Part D need to be addressed.

Exhibit 1:

Differences in risk-adjusted mean spending among Medicare patients with HIV versus Medicare patients without diagnosed HIV, 2016 Sources/Notes: SOURCE Authors’ analysis of Medicare claims data year, 2016. NOTES Direct HIV treatment was all medical treatment for HIV, which included all Parts A and B claims with a primary diagnosis of HIV/AIDS (excluding ART). HIV-associated conditions and infections included all spending related to claims with a primary diagnosis of HIV-related opportunistic conditions and all other infections as well. Spending on mental health disorders was related to all claims with a primary diagnosis of a mental health condition. Other medical condition spending was related to all remaining Medicare claims. ART is antiretroviral therapy.

Exhibit 3:

Risk-adjusted spending among Medicare beneficiaries by HIV status and number of months receiving antiretroviral therapy (ART), 2016 Source: SOURCE Authors’ analysis of Medicare claims data year, 2016.