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  Glasgow HIV
28 - 31 October 2018
Glasgow, UK
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Annual Comorbidity Cost Averages $8674 in German Analysis of People With HIV
  HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow
From Jules: I think this annual comorbidities costs are an underestimate. Imagine 1 patient with for example 4 comorbidities: osteoporosis plus or without a fracture; diabetes, heart disease, kidney disease. The annuals costs for medications and hospitalizations & office visits are I think much higher than estimated here.
Mark Mascolini
Annual comorbidity costs average $8674 in people with HIV in Germany, according to an insurance claims analysis [1]. Annual estimated costs for individual comorbidities range from about $2900 to $18,000.
As people with HIV live longer, they face a growing risk of age-related non-HIV comorbidities that take a rising toll in mortality. Extensive research has explored the clinical consequences of comorbidity, but little work addresses the economic impact.
To address that question researchers at Munich's MUC Research and coworkers at other centers conducted this retrospective cohort study using the German InGef health insurance claims database. They included people with 1 or more HIV ICD-10-GM codes in every calendar year from 2011 through 2014. Everyone was at least 18 years old in 2011 and had follow-up data through 2015. Health-related costs in Euros included outpatient and inpatient costs, all medication costs, and other health-related costs such as devices and sick-leave pay. To estimate the contribution of comorbidity to total healthcare costs, the researchers used a multivariable generalized linear regression model. Right now 1 Euro equals $1.14.
Among 2240 identified people with HIV, 2105 met eligibility criteria for inclusion in the analysis. Most participants, 82.6%, were men, and median age stood at 47.8 years (interquartile range 40.3 to 55.3, range 21.5 to 91.8). The most prevalent chronic comorbidities were hypertension (in 29.4%), abnormal lipids (23.5%), chronic pulmonary disease (18.3%), cardiovascular disease (15.2%), chronic HCV infection (8.5%), and diabetes (8.3%). The most frequent acute comorbidities diagnosed during follow-up were cardiovascular disease (12.7%), fractures (9.0%), HCV (2.4%), HBV (2.1%), and renal disease (1.3%).
Annual average total comorbidity costs came to 7609 Euros ($8674), which made up 34.8% of all annual care costs including ART. Non-ART medications cost an average 4196 Euros ($4783) yearly, representing 19.2% of total costs including ART. Yearly inpatient costs averaged 1467 Euros, outpatient costs 1589 Euros, and other comorbidity costs 357 Euros.
For individual comorbidities, the estimated annual cost was 16,023 Euros ($18,266) for chronic HCV infection, 14,525 Euros for acute HCV, 7366 Euros for acute kidney disease, 4791 Euros for acute cardiovascular disease, 3511 Euros for fractures due to osteoporosis, and 2581 Euros ($2942) for diabetes.
The researchers believe their findings underline "the importance of comorbidity management" in people with HIV, including prevention through lifestyle changes and "optimal ART selection to decrease the medical and economic burden related to comorbidities."
1. Wolf E, Christensen S, Diaz-Cuervo H. The economic burden of comorbidities among people living with HIV in Germany: a cohort analysis using health insurance claims data. HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract O116.