Economic Burden of HIV in a Commercially Insured Population in the United States

Cindy Chen, Prina Donga, Alicia Campbell, Babafemi Taiwo
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Abstract

Background: With advances in antiretroviral therapy (ART), people with HIV infection are living longer. Pre-exposure prophylaxis (PrEP) to reduce HIV infection risk continues to be underutilized in high-risk individuals. Recent data on economic burden for patients with newly diagnosed HIV-1 or initiated with PrEP are limited. Objectives: To assess characteristics, healthcare resource utilization (HRU), and costs among adults and adolescents either with newly diagnosed HIV-1 or initiated with PrEP. Methods: This retrospective observational study utilized data from the IBM MarketScan® Commercial Claims and Encounters database. Adults with newly diagnosed HIV-1 or those initiated with PrEP were included (index date was the first HIV diagnosis or PrEP prescription, respectively, between January 1, 2016, and April 30, 2021). Corresponding cohorts of adolescents were considered exploratory. Descriptive analyses were conducted to assess baseline demographics and clinical characteristics, and all-cause and HIV-related HRU and costs per patient per month (PPPM) during follow-up. Results: Data from 18 154 adults and 220 adolescents with newly diagnosed HIV and 34 123 adults and 175 adolescents initiated with PrEP were included. Approximately 70% of adolescents and 9% of adults receiving PrEP were female. Baseline depression/anxiety was present in 16.1% and 24.6% of adults and 14.5% and 45.1% of adolescents in the HIV and PrEP cohorts, respectively. Substance abuse in the HIV and PrEP cohorts, respectively, was reported in 10.1% and 7.0% of adults, and 2.7% and 17.7% of adolescents. During follow-up, among adults with newly diagnosed HIV, mean (SD) total all-cause and HIV-related PPPM costs were $2657 ($5954) and $1497 ($4463), respectively; pharmacy costs represented 47% of all-cause costs and 67% of HIV-related costs, but only 37% of patients had an HIV-related prescription. All-cause costs PPPM for adults with PrEP were $1761 ($1938), with pharmacy costs accounting for 71%. Conclusions: Despite advances in ART, patients with newly diagnosed HIV and at-risk patients receiving PrEP continue to incur HRU costs. The chronic nature of HIV warrants further exploration of factors contributing to disease burden and opportunities to improve prevention strategies.
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美国商业保险人群中HIV的经济负担
背景:随着抗逆转录病毒治疗(ART)的进展,艾滋病毒感染者的寿命延长了。在高危人群中,减少艾滋病毒感染风险的暴露前预防(PrEP)仍然没有得到充分利用。最近关于新诊断的HIV-1患者或开始使用PrEP的患者经济负担的数据有限。目的:评估新诊断HIV-1或开始PrEP的成人和青少年的特征、医疗资源利用率(HRU)和成本。方法:本回顾性观察性研究利用了IBM MarketScan®商业索赔和遭遇数据库的数据。新诊断为HIV-1的成年人或开始使用PrEP的成年人被纳入(索引日期分别为2016年1月1日至2021年4月30日之间的首次HIV诊断或PrEP处方)。相应的青少年队列被认为是探索性的。进行描述性分析以评估基线人口统计学和临床特征,以及随访期间全因和hiv相关的HRU和每个患者每月的费用(PPPM)。结果:纳入18 154名成人和220名青少年新诊断艾滋病毒和34 123名成人和175名青少年开始PrEP的数据。大约70%接受PrEP的青少年和9%的成年人是女性。在HIV和PrEP队列中,分别有16.1%和24.6%的成年人以及14.5%和45.1%的青少年存在基线抑郁/焦虑。在HIV和PrEP队列中,分别有10.1%和7.0%的成年人以及2.7%和17.7%的青少年报告了药物滥用。在随访期间,在新诊断为HIV的成年人中,全因和HIV相关PPPM的平均(SD)总成本分别为2657美元(5954美元)和1497美元(4463美元);药费占全因费用的47%,占艾滋病毒相关费用的67%,但只有37%的患者有与艾滋病毒相关的处方。使用PrEP的成人的全因成本PPPM为1761美元(1938美元),其中药房成本占71%。结论:尽管抗逆转录病毒治疗取得了进展,但新诊断的艾滋病毒患者和接受PrEP的高危患者继续承担HRU费用。艾滋病毒的慢性性质需要进一步探索造成疾病负担的因素和改进预防战略的机会。
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CiteScore
3.00
自引率
0.00%
发文量
55
审稿时长
10 weeks
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