Purpose: Few have looked at healthcare costs for children/teens with HIV/AIDS despite 6,726 prevalent US cases. We compared costs and healthcare utilization across three treatment eras: monotherapy (pre-1990), combination: two drugs (1990-1996) and HAART: three or more than three drugs (1997-present) and determined longitudinal cumulative cost at different ages for HIV positive patients born in these treatment eras.
Methods: We reviewed 350 charts to collect healthcare utilization on 126 infants born to HIV+ mothers over 29 years at a major HIV/AIDS specialty clinic from 1986 through 2007. 1999 costs were assigned for drugs (Redbook) and all HIV-related inpatient and outpatient medical visits (medical costs) from MFS/CPT codes. Generalized estimating equations and random-effects regression models were used to compare and estimate costs across treatment eras and at different ages for HIV+ cases. All costs were adjusted to 2007 dollar.
Results: Seventy-one patients were HIV negative and 55 patients were HIV (+). Average total costs/HIV(+) person/year in the mono-therapy era was $15,775; $26,122 in the combo-therapy era; and $16,778 in HAART era. Drug cost for HAART era was about 8% higher than combo but the differences were not significant. For medical costs, the costs were 66% (p<0.000) and significantly lower, for HAART era compared to combo. Similarly for total healthcare cost, HAART era had about 35% (p<0.019) and significantly lower cost than combo. Regression models were used to estimate the extrapolated cumulative costs over 15 years which was highest for monotherapy followed by combo and HAART eras. The length of time between date of birth and diagnosis had a significantly increasing effect on total costs. National cost savings in US due to using HAART vs combo drug therapy; estimated based on current numbers of pediatric HIV/AIDS patients in the US is $35 million/year. The cumulative cost of HIV positive patients at 5 year intervals from birth was consistently highest in the mono-therapy era followed by combo- and HAART era with lowest costs.
Conclusion: Total treatment cost savings associated with the HAART treatment of pediatric HIV disease when examined across the history of all treatment eras are substantial, primarily due to the trade-off between drug costs and inpatient and outpatient costs. This knowledge can assist healthcare practitioners when planning for adoption of new treatments as therapies evolve.
Candidate for the Lee B. Lusted Student Prize Competition