Aggressive Management of HIV Infections in an HMO Setting [Merrill D IDCP 2001;10:S20] The author reports a cost analysis of the experience with HIV-infected patients in the Kaiser Permanente Mid-Atlantic states system from 1993 through 2000. Care for HIV was provided exclusively by infectious disease-trained physicians, and antiretroviral prescribing was limited to this group. Analysis of data for 1999 compared with 1995 showed an increase in the number of patients with CD4 cell count >500 from 16% to 25%; the number of patients with CD4 cell counts <50/mm³ decreased from 25% to 15%. During this time the cost of HIV care per patient showed a modest increase to an average of $14,285/year in 1999. Data for sequential costs are shown in the following table:

Cost of HIV Care
	1993	1995	1997	1999
No. patients	607	798	1239	1445
Cost/pt.	$11,558	$11,167	$13,652	$14,285

Comment: The Kaiser system offers a unique opportunity for cost analysis because the patients get all of their care from one system, and their costs are carefully tracked. This group has a unique method to assure that care is provided by properly trained physicians in that pharmacy access to antiretroviral drugs is limited to those trained in infectious diseases. As expected, there was a substantial decrease in the per patient cost of hospitalization and a substantial increase in the cost of drugs, outpatient visits, and laboratory testing due to HAART. It is interesting that the overall cost of care has stayed relatively stable or showed a modest increase. The results must be interpreted with caution because they are not stratified by CD4 cell count and prior reports have shown that the cost of care increases substantially when the CD4 cell count is <50/mm³ [JAIDS 1998;18:S38].
posted 1/18/2002

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