Impact of Practice Changes on an Antiretroviral Budget in an HIV Care Program
Hartmut B Krentz
M. John Gill
Background: Antiretroviral (ARV) drugs account for >70% of the direct costs of HIV care. Changing practices in the use of ARV drugs may have major cost implications for the care budget within a regional population. Objective: To characterize and quantify the precise changes in the use of ARV within an entire HIV-infected population and to develop an approach to monitor the cost impact of future changes on the ARV budget. Design, Setting, and Participants: Socio-demographic, clinical, and primary-costing data were obtained from all 1218 HIV-positive patients receiving HIV care and living within southern Alberta, Canada between 1995 and 2003. Main Outcome Measures: Mean per patient per month (PPPM) costs in $Can (2003 values) were used for the basis of comparison. Actual and predicted changes in costs are presented as percentage changes. Results: After increasing 226% between 1996 and 1998, total PPPM ARV costs climbed only 6.7% from 1998 and 2003. Four counterbalancing forces contributed to this relative stabilization in costs: (i) the increased use of four or more ARV drugs to treat resistant HIV; (ii) the use of newer, more expensive ARV drugs (both [i] and [ii] increased total ARV costs by 22%); (iii) a delay in initiating ARV therapy to a lower CD4 count threshold; and (iv) the increased use of treatment interruptions (both [iii] and [iv] decreased total ARV costs by 15.3%). Increased or decreased use of these practices differentially affected mean ARV costs by 5-25% or more. Conclusions: Changing medical practices in terms of ARV use may have a major impact on the ARV budget. Detailed knowledge of both the entire HIV population being served, along with comprehensive information on current and planned changes in ARV use are essential for projecting both immediate and longer term funding.
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