AEGiS-13IAC: Enhanced cost effectiveness and improved clinical outcomes in Expert Physician managed HIV primary care in an Inner City Hospital HIV Clinic.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Enhanced cost effectiveness and improved clinical outcomes in Expert Physician managed HIV primary care in an Inner City Hospital HIV Clinic.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB119)

Wong M, Fisher E, Thompson-Bodkins C, Mercier B, Kaplowitz L
M. Wong, Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 330 Brookline Ave, Kennedy 6, Boston, Mass., 02215 USA, United States, Tel.: +(617) 632-0771, Fax: +(617) 632-0760, E-mail: mwong@caregroup.harvard.edu

BACKGROUND: HIV care provided in inner-city hospitals in the US is largely uncompensated; the impact of this care is not well delineated.

METHODS: Retrospective review of hospital service and billing data, and the MCV HIV Clinic computerized clinical database from 1 Jan 1995- 30 Dec 1998. Groups compared were those who receive their primary HIV care in the HIV Clinic (C) vs. Non-Clinic (NC) clients.

RESULTS: Demographics are largely African American, male, with drug use the primary risk factor. Clinic enrollment was 526, 1107, 1227, and 1357 for 1995-8, and 211, 369, 348, and 271 NC clients. C clients had median increases in CD4 count by 100 cells/mm³ per year since HAART and median circulating HIV Viral Loads decreases by -0.63 log, 1997, and -0.33 log, 1998. In Clinic patients, OIs decreased significantly. There was no gender or ethnic disparity in the prescribing of HAART in this cohort. Total cost of care for the C vs. NC clients by year were: $485K vs. $1,790K, $1,492K vs. $3,500K, $2,364K vs. $3,126K, and $2,411K vs. $2,391K. Pre-HAART, there were no differences in hospitalizations in either group, but length-of-stay (6.92 v 11.00 days, p>0.01), and costs for all care were lower in C vs. NC. ED visits and hospitalizations decreased for C clients following initiation of HAART regimens; no significant changes were observed in NC. The per member per month costs are significantly lower for C vs NC in 1995-1998 ($77 vs $707, $112 vs $790, $166 vs 748 and $148.06 vs 735, 1995-8, respectively)

CONCLUSIONS: These data support: 1) the importance of early HIV diagnosis and care; 2) the decreased resource utilization for expertly managed patients since HAART; and 3) the cost and outcome effectiveness of HIV care managed by experts.

Keywords: AEGIS, HIV Infections, Antiretroviral Therapy, Highly Active, Cost-Benefit Analysis, Primary Health Care, Ambulatory Care Facilities, CD4 Lymphocyte Count, HIV Seropositivity, Hospitalization, Risk Factors, Costs and Cost Analysis, Health Resources, Retrospective Studies, Human, Male, economics
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MoOrB119