1019 - Healthcare Resource Utilization and Cost of People Living with HIV (PLWH) in US Commercial and Medicare Advantage Health Plans

Background: The goal of HIV treatment is to achieve and maintain virologic suppression to prevent disease progression.  Patients with uncontrolled HIV and decreasing CD4 counts can experience more health problems and increased health care resource utilization (HCRU) and cost.  The objectives were to describe the clinical characteristics, HCRU and cost of PLWH in US Commercial and Medicare Advantage health plans by CD4 count.

Methods: A retrospective cohort study of PLWH aged 18+ between 01/01/2014-03/31/2018 in the Optum Research Database was conducted. Patients were continuously enrolled 6 months before (baseline) and 12 months after (unless evidence of death) the first identified antiretroviral (ARV) therapy (follow-up).  Patients were classified as heavily treatment-experienced (HTE) if their regimen indicated an ARV therapy used to treat multi-drug resistant (MDR) virus, Non-HTE if treatment did not include an HTE regimen, or Treatment-Naïve if they were not treated with any ARV medication during baseline.  All variables were summarized descriptively by the CD4 count closest to the first ARV regimen and compared using chi-square or F-test/ANOVA.

Results: 5,522 patients met the inclusion criteria including 18% with a CD4 count < 200, 70% 200-500, and 12% > 500 cells/mm³.  Patients in the lowest CD4 group were more likely to be HTE or Naïve, African-American, female, living in the South, earn less and have at least one AIDS defining condition (Table 1).  Patients in the lowest CD4 group also had the highest mortality rate, (6% in the < 200, 2% 200-500, 1% in the > 500 group; p-value < 0.001) and the highest rates of emergency room visits and inpatient stays (Figure 1).  All-cause total cost among patients with CD4 counts < 200 was 51% higher than those with CD4 > 500, and medical cost was 207% higher driven primarily by inpatient health care cost.  Similar trends were seen for HIV-related care.  Among the lowest CD4 group, average total cost was highest in the HTE group followed by Naïve patients.Table 1. Baseline Characteristics by CD4 count group, cells/mm3
Figure 1. Percentage of Patients with All-cause and HIV-related Healthcare Utilization by CD4 Group


Conclusion: There are still PLWH with CD4 counts < 200 cells/mm³ which can result in more AIDS defining conditions, higher mortality risk, and higher HCRU and cost.  These results suggest interventions may be needed to diagnose and treat patients sooner and closely monitor the health of more advanced patients for worsening outcomes.