The Costs of HIV Antiretroviral Therapy Adherence Programs and Impact on Health Care Utilization

Abstract

From a trial comparing interventions to improve adherence to antiretroviral therapy-directly administered antiretroviral therapy (DAART) or an intensive adherence case management (IACM)-to standard of care (SOC), for HIV-infected participants at public HIV clinics in Los Angeles County, California, we examined the cost of adherence programs and associated health care utilization. We assessed differences between DAART, IACM, and SOC in the rate of hospitalizations, hospital days, and outpatient and emergency department visits during an average of 1.7 years from study enrollment, beginning November 2001. We assigned costs to health care utilization and program delivery. We calculated incremental costs of DAART or IACM v SOC, and compared those costs with savings in health care utilization among participants in the adherence programs. IACM participants experienced fewer hospital days compared with SOC (2.3 versus 6.7 days/1000 person-days, incidence rate ratio [IRR]: 0.34, 97.5% confidence interval [CI]: 0.13-0.87). DAART participants had more outpatient visits than SOC (44.2 versus 31.5/1000 person-days, IRR: 1.4; 97.5% CI: 1.01-1.95). Average per-participant health care utilization costs were $13,127, $8,988, and $14,416 for DAART, IACM, and SOC, respectively. Incremental 6-month program costs were $2,120 and $1,653 for DAART and IACM participants, respectively. Subtracting savings in health care utilization from program costs resulted in an average net program cost of $831 per DAART participant; and savings of $3,775 per IACM participant. IACM was associated with a significant decrease in hospital days compared to SOC and was cost saving when program costs were compared to savings in health care utilization.

Utilization of Medical Treatments and Adherence to Antiretroviral Therapy among HIV-Positive Adults with Histories of Childhood Sexual Abuse

“…Prior studies of marginalized HIV-infected samples found that participants overestimated outpatient visits and medication adherence, [63][64][65] so rates of treatment utilization in this study may have been even lower than reported. 64,66,67 Future studies might consider multiple assessment methods, including medical record review and Medication Event Monitoring System, and lower adherence thresholds to account for improvements in ART regimens. 12,64,65 Nevertheless, self-reported adherence to ART has been found to predict virologic failure, 68 and it was predictive of immune functioning in this study.…”

“…Prior research has found that HIV case management can improve treatment utilization, including more outpatient visits and fewer hospital days, with lower overall health care costs. 64,66,67 Thus, many HIV-positive adults with CSA might benefit from case management or other interventions to help address psychosocial problems that interfere with optimal treatment utilization.…”

Piloting a Peer-Driven Intervention Model to Increase Access and Adherence to Antiretroviral Therapy and HIV Care among Street-Entrenched HIV-Positive Women in Vancouver

“…This is less than some programs (e.g., intensive individual-based) 29 but more than others (e.g., pillbox organizers). 30 The incentive provided to PDI participants ($30 per week) is relatively high, and comprises three quarters of the total program cost; it is feasible that this could be reduced without compromising participation.…”

Costs and cost–effectiveness of HIV community services: quantity and quality of studies published 1986–2011

“…Unit costs for HICs ranged between US$212 and 28,884, for UMICs between US$8 and 1806, and for LICs the unit cost was US$17,575 (TABLE 7) . Cost-effectiveness analysis of some of these services was performed in HICs and LICs and results were US$14,802 and US$1294-2000, respectively Home-based care 204 [80] 4 [76] Mobile testing 24-64 [34] Door-to-door counseling 15-24 [35] Household member HCT 37-39 [53,75] Rapid testing in transgender community 650-693 [86] Peer referral for MSM 392 [65] Per HIV-positive client tested 428-515 [34] Per client notifi ed of serostatus [77] 217-647 [34] Person notifi ed of new diagnosis 4013-18,740 [52] Transgender community 3817-8874 [86] Newly infected MSM 10,165-13,439 [66] Per person confi rmed with HIV diagnosis…”