Estimating the National Cost of Treating People with HIV Disease: Patient, Payer and Provider Data [Hellinger FJ and Fleishman JA. JAIDS 2000; 24: 182]: The authors estimate the cost of HIV by adding the totals for each payer source according to records from 1996. The results were the following: Medicaid - $2.8 billion, Medicare - $1.1 billion, Ryan White funds - $0.7 billion, VA - $0.3 billion, private insurers - $2.0 billion and "out-of-pocket expenses" (at $1,000/patient/year) - $0.3 billion. The total is $7.2 billion. Assuming that 335,000 people receive care, as reported by the HCSUS survey, the conclusion to be drawn is that the average annual cost of treating a patient with HIV infection is $20,000 - $24,400.
Comment: The HCSUS report also estimated the cost of HIV care at about $20,000/year [NEJM 1998; 339: 1987]. There are two major limitations of these data: first, both reports are from 1996, which was at the dawn of HAART, which revolutionized outcome and had a profound impact on costs as well. The second concern is that HIV-related costs other than pharmaceuticals are driven largely by CD4 cell counts, and there is an extraordinary jump when the CD4 cell count falls below 50/mm³. The cost for care of patients with CD4 cell counts above 50/mm³ are driven primarily by co-morbidities such as mental health problems, complications of substance abuse and other disease conditions such as renal failure or HCV infection. Pharmaceuticals have added substantially to the cost of treatment while notably decreasing the cost in managing HIV-associated complications. The point is that any financial analysis of HIV care needs to include consideration of these critical variables, and the CD4 cell count is by far the most important variable. Nevertheless, the data supplied in this report are potentially important in discussions regarding HIV reimbursement policies. posted 8/11/2000