Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

Leibowitz, Arleen; Desmond, Katherine A.

doi:10.2105/ajph.2014.302263

Cited by 23 publications

(23 citation statements)

References 13 publications

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“…In addition, the treatment cost of patients with a CD4 level of <100 cell/mm 3 was two-fold higher than that of patients with a CD4 level of 100-300 cell/mm 3 or >300 cell/ mm 3 . These findings are similar to those reported in the international literature [10][11][12][13][14][15][16][17]. A limitation of the present study is the study sample, which consisted of patients who attended a university hospital.…”

Section: Analysis Of the Treatment Costs Of Hiv/aids In Turkeysupporting

confidence: 91%

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Analysis of the treatment cost of HIV/AIDS in Turkey

Kockaya¹,

Zengin²,

Yenilmez

et al. 2016

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OBJECTIVE: Infection with the human immunodeficiency virus (HIV), the causative agent of acquired immune deficiency syndrome (AIDS), is a major global health problem. Patients with HIV can live normal lives with today’s new treatment options. As the treatment is generally successful, the life expectancy of patients infected with HIV is rising. As a result, the economic burden of HIV treatment on health systems is set to increase. According to the Ministry of Health, there were more than 6000 HIV-positive patients in Turkey in 2013. The aim of this study was to determine the direct costs of HIV treatment in Turkey.METHOD: A retrospective data analysis was performed from the reimbursement agency perspective. Data for 252 patients at a university hospital in Ankara from 2001 to 2012 were used for the analysis. The average costs of treatment per HIV patient and the average costs per HIV patient, depending on the state of the patient’s health, were calculated. The latter was determined according to the number of CD4 cells/ml, as defined by the CDC’s classification system for HIV infection. The cost of treatment was calculated based on published reimbursement prices in 2013, per patient per year.RESULTS: The CD4 values of 25.3%, 29%, and 45.7% of the 252 patients were <100 cells/mm3, 100–300 cells/mm3, and >300 cells/mm3, respectively. The treatment costs per patient per year for 2013 for those with CD4 values of <100 cells/ mm3, 100–300 cells/mm3, and >300+ cells/mm3 were $ 5,637.04, $ 2,211.54, and $ 2,182.35, respectively. The weighted average of the treatment cost per patient was $ 3,344.64 for 2013.CONCLUSION: This analysis is unique to Turkey and calculates the cost only of HIV treatment in Turkey. Lower CD4 values are associated with higher treatment costs. Appropriate HIV treatment is crucial for controlling CD4 values and lowering the treatment costs of HIV patients. These findings need to be considered by policy makers who may need to focus on HIV.

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Section: Analysis Of the Treatment Costs Of Hiv/aids In Turkeysupporting

confidence: 91%

“…Another analysis based on Medicaid claims in the state of California reported that the medical cost per patient was $ 36,469 [12]. The cost of HIV treatment per patient was estimated to be € 11,638, € 32,110, € 14,821, € 6,399, and € 25,340 in Spain, Germany, France, Italy, and the U.K. respectively [13].…”

Section: Resultsmentioning

confidence: 99%

Analysis of the treatment cost of HIV/AIDS in Turkey

Kockaya¹,

Zengin²,

Yenilmez

et al. 2016

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“…[1] Leibowitz and Desmond, analyzing 2007 Medicaid data from California, also limited analyses to those in Medicaid FFS care and excluded those in managed care plans or those enrolled in Medicare. [13] They estimated per capita FFS Medicaid expenditures for medical and pharmaceutical claims to be $36,469. In the current study, the mean Medicaid FFS payment for medical care in 2007, without inflation adjustment, was comparable: $34,318 (n=2,543).…”

Section: Discussionmentioning

confidence: 99%

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

Fleishman

Monroe

Voss³

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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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.

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“…An algorithm that required an HIV diagnosis in two outpatient claims or one inpatient claim was used to identify adult beneficiaries with strong evidence of HIV. 27 Our analyses included only fee-for-service Medicare and Medicaid enrollees because available data for Medicare managed care enrollees lack diagnosis fields needed to confirm HIV status. Medicaid-only beneficiaries (not dually enrolled in both Medicaid and Medicare) with visits to federally qualified health centers or rural health centers were excluded due to limited coding of procedures in these claims.…”

Section: Datamentioning

confidence: 99%

Quality of Care for HIV/AIDS and for Primary Prevention by HIV Specialists and Nonspecialists

Landovitz¹,

Desmond²,

Gildner³

et al. 2016

AIDS Patient Care and STDs

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The role of HIV specialists in providing primary care to persons living with HIV/AIDS is evolving, given their increased incidence of comorbidities. Multivariate logit analysis compared compliance with sentinel preventive screening tests and interventions among publicly insured Californians with and without access to HIV specialists in 2010. Quality-of-care indicators [visit frequency, CD4 and viral load (VL) assessments, influenza vaccine, tuberculosis (TB) testing, lipid profile, glucose blood test, and Pap smears for women] were related to patient characteristics and provider HIV caseload. There were 9377 adult Medicare enrollees (71% also had Medicaid coverage) and 2076 enrollees with only Medicaid coverage. Adjusted for patient characteristics, patients seeing providers with greater HIV caseloads (>50 HIV patients) were more likely to meet visit frequency guidelines in both Medicare [98%; confidence interval (CI 97.5-98.2) and Medicaid (97%; CI 96.2-98.0), compared to 60% (CI 57.1-62.3) and 45% (CI 38.3-50.4), respectively, seeing providers without large HIV caseloads (p < 0.001). Patients seeing providers with larger caseloads were significantly more likely to have CD4 (p < 0.001), VL (p < 0.001), and TB testing (p < 0.05). A larger percentage of patients seeing large-volume Medicare providers received influenza vaccinations. Provider caseload was unrelated to lipid or glucose assessments or Pap Smears for women. Patients with access to large-volume providers were more likely to meet clinical guidelines for visits, CD4, VL, tuberculosis testing, and influenza vaccinations, and were not less likely to receive primary preventive care. Substantial insufficiencies remain in both monitoring to assess viral suppression and in preventive care.

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Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

Cited by 23 publications

References 13 publications

Analysis of the treatment cost of HIV/AIDS in Turkey

Analysis of the treatment cost of HIV/AIDS in Turkey

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

Quality of Care for HIV/AIDS and for Primary Prevention by HIV Specialists and Nonspecialists

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