The Costs of Medical Care in HIV Disease. R Moore, R Chaisson. Johns Hopkins University School of Medicine, Baltimore, MD.

Objective: Medicaid is the principal payor of the medical care costs of patients with HIV infection. We wished to determine the costs to Medicaid of patients in Maryland infected with HIV as immunosuppression progresses, and to determine how costs varied by demographic characteristics of the patient.

Methods: We analyzed the complete statewide Medicaid claims for 458 patients followed since 1990 by the Johns Hopkins HIV Service who received care longitudinally in Maryland. Comparisons were made of Medicaid payments for all inpatient and outpatient services by sex, race, age, use of injecting drugs, and by CD4+ count (>500, 201-500, 51-200, 250 cells/mm3). A Markov model was used to estimate lifetime costs.

Results: During 9787 person-months of follow-up, a total of $9,741,213 in Medicaid payments was made. Mean monthly payments ranged from $2751 (Std. Error: $344) for patients with CD4+ counts ²50 cells/mm3 to $716 (SE: $65) for patients with CD4+ counts >500 cells/mm3. Mean inpatient costs were almost 60% of mean overall costs for CD4+ counts ²50 cells/mm3, falling to 47% for CD4+ counts >500 cells/mm3. For those with CD4+ counts ²50 cells/mm3, outpatient pharmacy costs averaged $587 (SE: $111) monthly, second only to inpatient costs. There were no differences in costs by sex, race, age, or injecting drug use in bivariate or multivariate analysis after adjusting for CD4+ count. Lifetime costs for treating an HIV-infected patient who presents with a CD4+ count>500 cells/mm3 are $120,000 over 7.9 years of life.

Conclusions: Average costs to Medicaid of treating patients in Maryland infected with HIV are similar across all demographic groups and increase about three-fold as the CD4+ count declines from >500 cells/mm3 to ²50 cells/mm3. Interventions that decrease hospitalization are most likely to decrease overall costs.

Contact: Richard D. Moore, M.D. Johns Hopkins University, 1830 E. Monument St., #8059, Baltimore, Maryland 21205, USA. Telephone: 410.955.2144, Fax: 410.955.4634, email: rmoore@welchlink.welch.jdu.edu. The Johns Hopkins AIDS Service web site is located at: http://www.hopkins-aids.edu.

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