Expenditures for the Care of HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy

dc.contributorVirginia Techen
dc.contributor.authorBozzette, Samuel A.en
dc.contributor.authorJoyce, Geoffreyen
dc.contributor.authorMcCaffrey, Daniel F.en
dc.contributor.authorLeibowitz, Arleen A.en
dc.contributor.authorMorton, Sally C.en
dc.contributor.authorBerry, Sandra H.en
dc.contributor.authorRastegar, Afshinen
dc.contributor.authorTimberlake, Daviden
dc.contributor.authorShapiro, Martin F.en
dc.contributor.authorGoldman, Dana P.en
dc.description.abstractBackground: The introduction of expensive but very effective antiviral medications has led to questions about the effects on the total use of resources for the care of patients with human immunodeficiency virus (HIV) infection. We examined expenditures for the care of HIV-infected patients since the introduction of highly active antiretroviral therapy. Methods: We interviewed a random sample of 2864 patients who were representative of all American adults receiving care for HIV infection in early 1996, and followed them for up to 36 months. We estimated the average expenditure per patient per month on the basis of self-reported information about care received. Results: The mean expenditure was $1,792 per patient per month at base line, but it declined to $1,359 for survivors in 1997, since the increases in pharmaceutical expenditures were smaller than the reductions in hospital costs. Use of highly active antiretroviral therapy was independently associated with a reduction in expenditures. After adjustments for the interview date, clinical status, and deaths, the estimated annual expenditure declined from $20,300 per patient in 1996 to $18,300 in 1998. Expenditures among subgroups of patients varied by a factor of as much as three. Pharmaceutical costs were lowest and hospital costs highest among underserved groups, including blacks, women, and patients without private insurance. Conclusions: The total cost of care for adults with HIV infection has declined since the introduction of highly active antiretroviral therapy. Expenditures have increased for medications but have declined for other services. However, there are large variations in expenditures across subgroups of patients. (N Engl J Med 2001;344:817-23.)en
dc.description.sponsorshipSupported by a cooperative agreement (HS08578) between RAND and the Agency for Healthcare Research and Quality, with additional funding from the Health Services Resources Administration, the National Institute for Mental Health, the National Institute on Drug Abuse, and the National Institutes of Health Office of Research on Minority Health through the National Institute for Dental Research, and by a grant from the National Institute for Child Health and Human Development (R01-HD35040).en
dc.publisherNEJM Groupen
dc.rightsIn Copyrighten
dc.titleExpenditures for the Care of HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapyen
dc.title.serialThe New England Journal of Medicineen
dc.typeArticle - Refereeden


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