Abstract
BackgroundHIV disease itself is associated with increased healthcare utilization and healthcare expenditures. HIV-infected persons with lipodystrophy have been shown to have poor self-perceptions of health. We evaluated whether lipodystrophy in the HIV-infected population was associated with increased utilization of healthcare services and increased healthcare costs.ObjectiveTo examine utilization of healthcare services and associated costs with respect to presence of lipodystrophy among HIV-infected patients.MethodsHealthcare utilization and cost of healthcare services were collected from computerized accounting records for participants in a body image study among HIV-infected patients treated at a tertiary care medical center. Lipodystrophy was assessed by physical examination, and effects of lipodystrophy were assessed via body image surveys. Demographic and clinical characteristics were also ascertained. Analysis of healthcare utilization and cost outcomes was performed via between-group analyses. Multivariate modeling was used to determine predictors of healthcare utilization and associated costs.ResultsOf the 181 HIV-infected participants evaluated in the study, 92 (51%) had clinical evidence of HIV-associated lipodystrophy according to physician examination. Total healthcare utilization, as measured by the number of medical center visits over the study period, was notably increased among HIV-infected subjects with lipodystrophy as compared to HIV-infected subjects without lipodystrophy. Similarly, total healthcare expenditures over the study period were $1,718 more for HIV-infected subjects with lipodystrophy than for HIV-infected subjects without lipodystrophy. Multivariate modeling demonstrated strong associations between healthcare utilization and associated costs, and lipodystrophy score as assessed by a clinician. Healthcare utilization and associated costs were not related to body image survey scores among HIV-infected patients with lipodystrophy.ConclusionPatients with HIV-associated lipodystrophy demonstrate an increased utilization of healthcare services with associated increased healthcare costs as compared to HIV-infected patients without lipodystrophy. The economic and healthcare service burdens of HIV-associated lipodystrophy are significant and yet remain inadequately addressed by the medical community.
Highlights
HIV disease itself is associated with increased healthcare utilization and healthcare expenditures
Healthcare utilization and associated costs were not related to body image survey scores among HIV-infected patients with lipodystrophy
CD4 counts were higher and the interquartile range of HIV viral loads was lower in subjects with lipodystrophy vs. subjects without lipodystrophy
Summary
HIV disease itself is associated with increased healthcare utilization and healthcare expenditures. We evaluated whether lipodystrophy in the HIV-infected population was associated with increased utilization of healthcare services and increased healthcare costs. The HIV-associated lipodystrophy syndrome is characterized by alterations in body appearance related to changes in body fat stores and has been described in up to 80% of persons who have been exposed to antiretroviral therapies [1,2,3,4] These changes in body appearance have been shown to result in body image dysphoria and reduced body image-related quality of life among affected persons [5,6]. Poorer health perceptions [8] and quality of life [9] have both been associated with increased healthcare costs and utilization. Our a priori hypothesis was that HIV-infected patients with lipodystrophy would demonstrate increased utilization of healthcare services with an associated increase in healthcare expenditures as compared to HIVinfected patients without lipodystrophy
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