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HIV Late Presenters Cost Much More & Die Earlier
 
 
  Quicker HIV Care Would Save Money
 
MedPage Today
Published: November 20, 2010
Reviewed by Barry S. Zingman, MD; Professor of Clinical Medicine, Albert Einstein College of Medicine, Bronx, NY.
 
Action Points
 
* Note that these research results bolster the economic argument for early diagnosis of HIV and for effective linkage to care of people diagnosed with HIV.
 
* Note that these results add to already existing strong clinical information suggesting that early diagnosis and linkage to care improves outcomes in people with HIV infection.
 
Getting people into HIV care sooner is likely to save health care dollars, researchers reported.
 
People with HIV who started care late in the disease process had a cumulative cost of treatment that was up to $61,615 higher than those who presented early, according to John Fleishman, PhD, of the Agency for Healthcare Research and Quality in Rockville, Md., and colleagues.
 
And those who presented late -- with a CD4 T cell count of 200 cells or fewer per cubic millimeter of blood -- accounted for more than 40% of those treated in 10 major HIV clinics over a seven-year period. Fleishman and colleagues reported in the December issue of Medical Care.
 
The findings highlight the need to reduce the time between diagnosis and care, as well as between infection and diagnosis, the researchers concluded.
 
"It's important clinically to get people into care early because they will stay healthier and do better over the long run," according to Kelly Gebo, MD, of the Johns Hopkins University School of Medicine, who was the study's senior author.
 
"But now we know it's also more costly to the health care system for potentially decades and a serious drain on our limited health care dollars," Gebo said in a statement.
 
The study looked at 8,348 patients who started care in 2000 through 2006 in 10 HIV clinics that are part of the HIV Research Network, the researchers reported.
 
Those with 200 or fewer CD4 cells per cubic millimeter of blood in their first test were defined as late presenters, and those with more than 500 were regarded as entering care early.
 
Those with 201 through 500 cells per cubic millimeter of blood were defined as intermediate but -- because some clinicians and researchers think 350 cells should be the defining line for late presentation -- the intermediate group was subdivided again at 350 cells.
 
Using medical records from 2000 through 2007, the researchers estimated the cost of care, including medication, inpatient stays, and outpatient visits, in order to examine the association between cost and initial CD4 count, stratified by years of care.
 
They found that 43.1% of the patients presented late and only 18.7% presented early. Another 21.4% were in the low intermediate group, and the remaining 16.8% were in the high intermediate group.
 
As well, analysis showed that for all periods, costs were higher for those who presented early. For example:
 
* The average cumulative cost for a late presenter with a year or less of care was $37,104, compared with $9,829 for an early presenter. The difference was $27,275 -- the smallest difference seen.
* The largest difference was in the group of patients in their fifth year of care. Late presenters had a cumulative cost, on average, of $92,213, compared with $30,598 for late presenters -- a difference of $61,615.
* The difference fell for those with more years of care, but remained substantial. For those in their seventh year of care, late presenters had a cumulative cost of $135,827, compared with $86,721 for those who presented early - a difference of $49,105.
 
The researchers noted late presenters were more likely to die, with mortality rates -- from low initial CD4 counts to high -- of 14.04%, 6.22%, 3.92%, and 3.84%. On the other hand, they were less likely to interrupt care.
 
They also noted that the 10 clinics involved in the study are not nationally representative. Moreover, they said the cost estimates may not generalize to less specialized centers.
 
The study was supported by the Agency for Healthcare Research and Quality and the National Institutes of Aging and Drug Abuse. The researchers did not report any conflicts.
 
Primary source: Medical Care
Source reference:
Fleishman JA et al "The economic burden of late entry into medical care for patients with HIV infection" Med Care 2010: 48.
 
 
 
 
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