Cost burden improved for pediatric patients with HIV

Wilson LS. Pediatrics. 2010;126:doi:10.1542/peds.2009-3485.

The introduction of antiretroviral therapy has lowered overall medical costs for children with HIV compared with eras in which only older forms of treatment were available, according to recent study data.

To evaluate changing health care costs for children with HIV, researchers from the Osher Center for Integrative Medicine in San Francisco and the University of California, San Francisco, reviewed medical records from three eras of HIV treatment — monotherapy, combination therapy and ART.

The researchers collected data on 126 children born between 1986 and 2007 to mothers with HIV or mothers at high risk for infection. Inclusion criteria also dictated that the children had at least 1 year of treatment data available and had received treatment at a University of California, San Francisco, pediatric HIV/AIDS specialty clinic. Some but not all children also participated in International Maternal Pediatric Adolescent AIDS Clinical Trials Group studies.

The researchers used the 1999 Drug Topics Red Book to determine drug costs. They also consulted the CPT Medicare fee schedule to find outpatient costs and the Healthcare Cost and Utilization Project Kids’ Inpatient Database for information on inpatient costs during the study period.

Forty-four percent of infants were HIV-positive and 56% were HIV-negative, according to the study data, with comparable numbers of male and female patients, as well as an equal distribution of race/ethnicities among both groups.

Results revealed that mean total health care cost per month was highest, totaling $2,289, during the combination-therapy era (1990-1996), when compared with $1,814 seen during the ART era (1997-2007) and $1,306 during the monotherapy era (1986-1989).

Cumulative health care cost for a person older than 15 years with HIV was $196,860 during the monotherapy era and $186,235 during the combination-therapy era. Cumulative costs were lowest during the ART era, at $181,436, the researchers said.

Analysis also indicated that drugs cost four times more during the ART era ($1,242) compared with the monotherapy era ($318) and 1.4 times more than during the combination-therapy era ($891).

The researchers noted, however, that total medical costs during the ART era — which were 23% lower when compared with the monotherapy era and 25.2% lower when compared with the combination-therapy era — balanced the higher cost of drugs. The 57% decrease in inpatient and outpatient costs during the ART era also contributed to significant decreases in the total price of medical care for children with HIV.

After performing an approximate 15-year cost savings analysis, the researchers found that using ART instead of monotherapy during 1986 to 1989 would have saved an estimated $22.3 million. Similarly, the availability of ART during the combination-therapy era of 1990 to 1996 would have saved about $6.7 million. All estimates, however, depend upon the same incidence of disease in each era.

“We demonstrated that the development of new treatments, although costly themselves, can act to decrease overall treatment costs when these treatments are translated quickly into clinical practice, as has occurred in pediatric HIV care,” the researchers wrote.

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