Expenditures for Persons Living With HIV Enrolled in Medicaid, 2006–2010

Abstract

Background Costs of care for persons living with HIV (PLWH) have been high historically. Cost estimates based on data from one health care site may underestimate total expenditures; using insurance claims avoids this limitation. We used Medicaid claims data to comprehensively assess payments for care for PLWH between 2006 and 2010. Methods Five sites from the HIV Research Network (HIVRN) provided information on patients with Medicaid coverage. Medicaid data were obtained from the sites’ states (MD, NY, and MA) and 3 surrounding states and matched to HIVRN medical record-based data. Individuals less than 18, those with Medicare, and those in Medicaid managed care plans were excluded. Medicaid and HIVRN data were compared to ascertain concordance in capturing any inpatient event and any antiretroviral medication (ART) use. Results Of 6,892 unique HIVRN identifiers, 6,196 (90%) were linked to Medicaid data. The analytic sample included 11,341 person-years of Medicaid claims data from 3,697 individuals in fee for service (FFS) programs. The mean annual FFS payment for all services was $47,434; mean annual FFS payment for only medical services was $38,311. Concordance between Medicaid and HIVRN data was excellent for ART use, but HIVRN data did not record a substantial proportion of years in which Medicaid recorded inpatient use. Conclusions Estimated Medicaid payment amounts in this study are higher than some prior estimates. More complete capture of expensive inpatient hospitalizations in Medicaid data may partially explain this finding. While inpatient care and ART medications contribute the most, expenditures for non-medical services are substantial.

Impact of comorbidity on the risk and cost of hospitalization in HIV-infected patients: real-world data from Abruzzo Region

“…Second, we found that cardiovascular, renal and pulmonary CMs, as well as HCV coinfection, are significantly associated with an increased risk of acute hospitalizations among PWL-HIV, in line with other reports in the literature. 18 , 20 , 46 , 48 These findings contribute to the idea that a more stringent control of such CMs may well be necessary in the setting of chronic management of HIV infection. Although much has been done in terms of research and development of newer antiretrovirals, with a more favorable profile of toxicity in all lines of HAART, efforts to reduce the prevalence of CMs in HIV patients need to be increased rather than reduced.…”

“…Acknowledging the paucity of information about this issue, in our country as well as in other countries, our analysis may be relevant to understand how HIV infection may still be causing health care resources utilization as well as health care expenditure in the present setting, beyond HIV testing, HAART expenditure and continuous efforts to improve high quality retention in care. 18 – 20 , 46 …”

“…Indeed, our analyses reveal that acute hospitalizations for comorbid HIV patients are costly, with up to four times higher expenditure compared with acute hospitalizations of non-comorbid PWLHIV, in line with other lines of evidence. 18 , 20 , 48 This evidence highlights that appropriate tailoring of antiretroviral therapy in accordance with HIV-associated CMs needs to be considered in order to reduce such acute events.…”

“…So, gathering better knowledge of factors that may affect the risk of hospital utilization by PWLHIV in the HAART era may well be an important goal both for clinicians and policy makers in the strive to understand how health care needs are probably changing in this population. 18 – 20 However, little is known at present on such a crucial issue. The aim of this study was to quantify the risk of hospitalization and costs associated with CMs in HIV-infected patients in a regional Italian cohort.…”

Injection Drug Use Among West Virginia Medicaid Beneficiaries: An Analysis of Health Outcomes, Service Utilization, and Cost

“…Treating one HIV case costs approximately $38,000 per year, with considerable variation dependent on disease stage. (Fleishman, Monroe, Voss, Moore, & Gebo, 2016) Further, the most recent available data estimates the total lifetime cost of treating one case of HIV to be between $253,000 and $402,000 depending on disease stage. (Farnham et al, 2013) Considering that approximately 9%, or 3,600 new cases of HIV in the US each year identify IDU as risk factor, approximately $136.8 million are spent on new HIV infections just among PWID.…”