Evaluation of Costs of Healthcare in HIV Patients with Anemia.

Abstract

Background: Although the prevalence of mild to moderate anemia in HIV+ patients (pts) is approximately 22% in the HAART era, the incremental economic burden of anemia is not well understood. This study provides an estimate of the incremental cost of care for anemia in HIV+ pts. Methods: A longitudinal, retrospective, cohort design was employed to identify subjects in a commercial database of medical and pharmacy claims who were ≥18 years, HIV+, and enrolled in 1 healthcare plan continuously for 18 months from 1996 to 2004. Pts with anemia (A+) were identified using ICD-9 diagnosis codes or receipt of transfusion(s) in the absence of major GI bleeding, trauma or surgery. A control period of 6 months immediately prior to the 12-month study period served to evaluate comorbidity burden and disease severity. To isolate health care costs, including in- and out-patient visits and pharmacy costs, specific to anemia, multivariate regression analyses were conducted to control for demographics, comorbidities, and disease burden. Results: Of the 2,195 HIV+ subjects identified, 364 (17%) were A+. While there was no significant gender effect, each 1-year increase in age was associated with a 2.1% rise in average monthly cost. A+ cohort was associated with a 118.5% higher average cost compared to A−. The unadjusted average monthly cost for A− subjects in the post-index period was $466 compared with $1,200 for the A+ cohort. In a regression model, anemia maintained an independent and significant association with increased costs (p < 0.0001). Conclusion: The presence of anemia is associated with a substantial increase in costs among HIV+ patients, independent of demographic differences, disease severity and comorbidity burden. Prospective studies are needed to evaluate the effect of anemia correction on healthcare costs in this population.