Impact of Protease Inhibitor—Containing Antiretroviral Therapy on Healthcare Costs of HIV-Infected Patients in a Multisite U.S. Sample

Abstract

Protease inhibitors (PIs) became widely available as an integral component of combination antiretroviral therapy in late 1995. PIs have dramatically changed the healthcare of HIV-infected patients and have ignited a debate regarding their cost-effectiveness. The objective of this study was to determine the effect of penetration of PIs on the total cost of care per member per month (PMPM) among five US cites caring for HIV-infected patients. Electronic health claims data for commercially insured, HIV-infected patients were reviewed at sites in five U.S. regions: Los Angeles (LA), San Francisco (SF), Seattle (SEA), Florida (F), and Dallas and Houston (TX). Costs PMPM by category of care (oral medications, hospitalization, professional fees, home healthcare, laboratory, and radiology) were analyzed over a 2-year period (1996–1997) to determine the impact of PI penetration on the expenditures for these specific services. PI use across each surveyed region varied considerably; however, by the end of 1997, an average of 60% of patients across all regions were receiving PIs. Even though oral medication costs increased an average of $85 PMPM across all regions, costs for other healthcare services decreased as much as $118 PMPM (hospitalization). Overall cost savings ranged from a decrease of $208 PMPM in the SEA region to a decrease of $90 PMPM in the F region. A net overall healthcare cost reduction for each 10% increase in PI penetration was $130 PMPM. In this study, PI-containing antiretroviral therapy significantly reduced morbidity and mortality associated with AIDS and resulted in an overall decrease in healthcare costs PMPM among patients from five U.S. regions.