What Is Inadequate Control of HIV Costing Your Plan?
Achieving viral suppression and preventing HIV transmission are key treatment goals for patients with HIV.1
of patients diagnosed with HIV fail to achieve viral suppression,
according to the Centers for Disease Control and Prevention.2
There are several factors that may result in additional HIV-related costs for payers3-5:
- Drug-resistant mutations
- Suboptimal adherence
- Increased disease progression
Poor patient adherence
due to comorbidities and
other psychosocial factors
Decreasing CD4 counts are a predictor of HIV disease progression, which may lead to worsening health and increased costs.
*This retrospective cohort study of a large US claims database used administrative claims representing more than 70 million lives in the US between July 1, 2013, and March 31, 2019, including medical and pharmacy claims. A total of 5,522 patients met the study criteria including: 1,117 heavily treatment-experienced, 2,394 treatment-experienced, and 2,011 treatment-naïve HIV patients. All study measures were summarized by CD4 count strata, <200, 200-500, or >500 cells/mm3.
†A retrospective cohort design of members living with HIV (N=2,030) was implemented using data from Magellan Health, Inc, a medical and pharmacy administrative claims database from multiple region health plans (Medicaid and commercial) in the United States between January 1, 2007, and June 30, 2016. Each patient was categorized on the basis of ART regimen pill burden. In the healthcare cost analyses, commerically insured patients were further divided into 2 cohorts on the basis of length of available follow-up data (<3 or ≥3 years). Adherence to ART medication (mean PDC) during the first 15 months was lower in Medicaid patients (65%) versus commercially insured patients (79%; P<0.0001). Medical costs included inpatient, outpatient, laboratory, emergency department, and other costs.
‡A retrospective cohort study of patients (N=15,602) at the Veterans Healthcare Administration between January 1, 2006, and July 30, 2012. Patients were followed from the index date until treatment discontinuation, end of study period, last date of healthcare-related activity, or death. High adherence was defined as a medication possession ratio of ≥95%.
§A retrospective cohort study of treatment-naïve patients (N=218) at an urban HIV clinic in the United States between 2006 and 2013 from multiple health plans (Medicaid, Medicare, commercial, self-pay, and hospital-based charity care). Patients were started on an STR or MTR as chosen by their provider, and continued on an uninterrupted and unchanged regimen for a minimum of 6 months. Patients switching therapy after 6 months were included in the study. Patients were assessed for viral load suppression at 6 and 12 months after initiating either an STR or MTR.
Open access to all ART regimens is important.
Help providers offer HIV patients the tailored care they need.
DHHS=Department of Health and Human Services; PDC=proportion of days covered.
HVUWCNT210007 August 2021