Financial Burdens of HIV Treatment and HCRU

People living with HIV have a higher financial burden and greater health care utilization than people without HIV, but heavily-treatment experienced people with HIV also have a greater burden than people with HIV who experienced less treatment.

Image credit: shefkate - adobe.stock.com

People living with HIV (PWH) continue to incur higher health care costs and are faced with a greater financial burden and greater health care resource utilization (HCRU) as treatment regimens become more complicated over time, according to 2 posters presented at the AMCP Nexus 2024 meeting, held October 14 to 17 in Las Vegas, Nevada.

Higher Health Care Costs

In the first poster, researchers conducted a matched (1:3) cohort study analyzing HCRU and direct costs among adult PWH and controls in the United States from 2018 to 2023.¹ They used the IQVIA Pharm-Metrics Plus adjudicated claims database to identify adult PWH who had received antiretroviral treatment and controls selected with exact matching on age, sex, region, and health plan type.

The analysis included 45,465 individuals in 2018; 47,482 in 2019; 51,460 in 2020; 49,869 in 2021; 51,592 in 2022; and 54,530 in 2023. The mean all-cause annual and cumulative costs for PWH were significantly higher than controls for all age groups. The difference in costs increased with age group from a difference of $34,643 in the 18- to 24–year age group ($38,308 for PWH vs $3665 for controls) to a difference of $47,105 in the 70 to 74 age group ($62,359 for PWH vs $15,254 for controls).

PWH had higher mean annual pharmacy, inpatient, outpatient medical, and emergency department costs compared with controls. The pharmacy costs accounted for the majority of total costs for PWH.

“Higher HCRU among PWH highlights the need for HIV prevention and screening, in addition to rapid initiation of antiretroviral therapy and retention in care,” the authors concluded.

The Burden of Heavy Treatment Experience

Utilizing the Veradigm Network electronic health record–linked claims database, the second poster highlighted how increasingly complex treatment regimens are creating greater burdens for patients who have a heavy treatment experience compared with patients with HIV who have experienced less treatment.²

The researchers used data from January 2015 to December 2022. They defined heavily-treatment experienced (HTE) PWH as having at least 1 of 4 specific HTE-defining criteria based on antiretroviral therapy (ART) indication and exposure, evidence of viremia, and/or ART resistance. Patients who are considered HTE have limited ART options, “owing to drug resistance and intolerance, potential loss of/changes to insurance, and/or concomitant medication interactions,” they wrote.

When a patient met the HTE criteria was considered the index date and the treatment patterns, HCRU, and costs for the 6 months after the index period were compared between HTE PWE and other treatment-experienced PWH. The 2 groups were matched on age group, sex, race, ethnicity, geographic region, year of index date, and payer type.

A total of 2836 HTE PWH were included, of them 2710 were matched with non-HTE PWH for the HCRU analysis. The researchers found the following regarding median costs:

• Medical plus pharmacy costs were $23,082 for HTE PWH vs $18,440 for non-HTE PWH
• All-cause medical costs were $3823 for HTE PWH vs $2935 for non-HTE PWH
• HIV-related health care was $17,799 for HTE PWH vs $14,678 for non-HTE PWH
• HIV-related medical was $1308 for HTE PWH vs $975 for non-HTE PWH

They concluded that pharmacy use and outpatient services contributed the most to increased costs for HTE PWH compared with the non-HTE counterparts.

“Compared with their non-HTE counterparts, meeting HTE PWH criteria was associated with a greater financial burden, including higher HIV-related and all-cause HCRU,” they wrote.

References

1. Cohen J, Anupindi R, Doshi R, et al. Overall and age-specific estimation of the annual incremental health care resource use and costs of HIV compared with non HIV population. Presented at: AMCP Nexus 2024; October 14-17, 2024; Las Vegas, Nevada. Poster B7.

2. Gupta S, Cappell K, Coaquira Castro J, et al. Treatment patterns and health care resource utilization of heavily treatment-experienced people with HIV. Presented at: AMCP Nexus 2024; October 14-17, 2024; Las Vegas, Nevada. Poster B10.