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The changing direct costs of medical care for patients with HIV/AIDS, 1995–2001

From the Southern Alberta HIV/AIDS Clinic (Krentz) and the Department of Medicine, Faculty of Medicine (Krentz, Gill), and the Department of Economics, Faculty of Social Science (Auld), University of Calgary, Calgary, Alta.HIV Economic Study Group: Dr. Hartmut B. Krentz, Southern Alberta Clinic, Calgary, Alta.; Dr. M. Christopher Auld, Department of Economics, University of Calgary, Calgary, Alta.; Dr. M. John Gill, Department of Medicine, University of Calgary, Alta.; Dr. Cam Donaldson, Department of Community Health Science, University of Calgary, Calgary, Alta.; Dr. Myron Weber, Haskayne School of Business, University of Calgary, Calgary, Alta.; Mr. Michael Henry, Southern Alberta Clinic, Calgary, Alta.

Correspondence to: Dr. Hartmut B. Krentz, Southern Alberta Clinic, 213–906 8th Avenue SW, Calgary AB T2P 1H9; fax 403 262-4893; Hartmut.Krentz{at}CalgaryHealthRegion.ca

Background: Determining the direct cost of providing medical care to patients with HIV/AIDS is important for both short-term and long-term decision-making and for appropriate resource allocation. We aimed to categorize and measure the direct costs of medical care provided to the entire HIV-positive population receiving care in southern Alberta between 1995 and 2001.

Methods: We collected all patient-specific direct costs including the cost of pharmaceutical drugs (HIV and non-HIV drugs), outpatient care (including physician costs and laboratory testing), inpatient (in-hospital) care and home care (acute, long-term, palliative) from primary sources for all patients between April 1995 and April 2001. We determined cost per patient per month (PPPM) adjusted to 2001 Canadian dollars.

Results: Since 1995, the direct cost of providing medical care to patients with HIV/AIDS has increased primarily as a result of increased antiretroviral drug costs both in absolute and in PPPM terms. Mean PPPM expenditures increased from $655 in 1995/96, that is, before the use of highly active antiretroviral therapy (HAART), to $1036 in 1997/98 when HAART was widely used. During the following 3 years, mean overall PPPM costs remained stable. Antiretroviral drugs accounted for 30% ($198 PPPM) of the total cost in 1995/96 increasing to 69% ($775 PPPM) in 2000/01. Inpatient, outpatient and home care costs decreased in both percentage and cost PPPM between 1995/96 and 2000/01 from 26% to 10%, 27% to 14% and 8% to 3% respectively.

Interpretation: The cost of providing medical care to HIV-positive patients continues to increase, although the burden of costs is distributed differently from before the introduction of HAART, with the costs of drug therapy offsetting the costs of inpatient care and home care. Careful consideration of all aspects of direct costing data is needed when any health economic policy issues are examined.

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