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HIV economic burden of illness in the Veterans Health Administration population

机译：退伍军人健康管理局人口的艾滋病毒经济负担

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The objective was to assess the human immunodeficiency virus (HIV) economic burden of illness in the Veterans Health Administration (VHA) population. Adults (aged 18-64 years) with a HIV diagnosis (International Classification of Diseases 9th Revision, Clinical Modification [ICD-9-CM] code 042.x, V08) from 1 June 2007 to 31 May 2012 were selected from VHA Medical SAS((R)) data-sets. Continuous VHA insurance coverage 12-month pre- and postindex date, with no antiretroviral therapy (ART) prescriptions within 180 days pre-index date, was required for treatment-naive (TN) HIV-infected patients. One baseline CD4 count or HIV viral load measured within three months after HIV diagnosis or one ART anchor drug claim postindex date was required for group comparison. All-cause health-care costs and utilizations were evaluated and stratified by CD4 cell count, viral load, nonnucleoside reverse transcriptase inhibitor (NNRTI) anchor drugs (efavirenzon-efavirenz), and ART (NNRTI/PI/INSTI/CCR-5 Antagonist-based) regimen cohorts. The overall economic burden was compared between HIV-infected vs. non-HIV-infected patients. CD4 count, viral load, and treatment patterns and the associated costs were compared among TN patients. A 1:1 propensity score matching (PSM) was used to adjust for baseline differences. A total of 25,648 HIV-infected patients were identified (mean age 51; 96.4% male; 49.7% non-Hispanic black) of which 11,371 were TN. HIV-infected patients incurred higher PSM-adjusted total costs than non-HIV-infected patients ($25,232 vs. $10,206, p < 0.0001). Total costs for TN with CD4 cell counts <= 50 cells/mm(3) were higher than all other CD4 cell strata (p < 0.001). Total costs for TN with viral loads >100,000 copies/mL were higher than all other viral load categories (p < 0.001). Efavirenz-treated patients incurred higher ART-related ($8663 vs. $2846, p = 0.0266), but lower non-ART-related ($2339 vs. $6628, p = 0.0042) pharmacy costs than non-efavirenz patients. NNRTI-based cohort incurred lower total costs than protease inhibitor-based ($32,829 vs. $39,073, p = 0.0005) but no significant differences compared to integrase strand transfer inhibitor cohorts. This study offers new health-care costs and resource utilization estimates associated with the burden of HIV in the VHA population.
机译：目的是评估退伍军人卫生管理局（VHA）人群中人类免疫缺陷病毒（HIV）的经济负担。从VHA Medical SAS中选出2007年6月1日至2012年5月31日具有HIV诊断（国际疾病分类第9版，临床修改[ICD-9-CM]代码042.x，V08）的成人（年龄在18-64岁之间）。 （（R））数据集。初次治疗（TN）的HIV感染患者需要连续的VHA保险覆盖索引前和索引后12个月的日期，并且在索引前180天内没有抗逆转录病毒疗法（ART）处方。组比较需要在HIV诊断后三个月内测量一个基线CD4计数或HIV病毒载量或一个ART锚定药物声明后日期。通过CD4细胞计数，病毒载量，非核苷逆转录酶抑制剂（NNRTI）锚定药物（efavirenz / non-efavirenz）和ART（NNRTI / PI / INSTI / CCR-5）对所有原因的医疗保健成本和利用率进行了评估和分层基于拮抗剂的治疗方案队列。比较了艾滋病毒感染者和非艾滋病毒感染者的总体经济负担。比较了TN患者的CD4计数，病毒载量和治疗方式以及相关费用。 1：1倾向得分匹配（PSM）用于调整基线差异。总共鉴定出25648例受HIV感染的患者（平均年龄51;男性96.4％;非西班牙裔黑人49.7％），其中TN为11371。与未感染HIV的患者相比，感染HIV的患者发生PSM调整后的总成本要高（分别为25,232美元和10,206美元，p <0.0001）。 CD4细胞计数<= 50细胞/ mm（3）的TN的总成本高于所有其他CD4细胞层（p <0.001）。病毒载量> 100,000拷贝/ mL的TN的总成本高于所有其他病毒载量类别（p <0.001）。与依非韦仑治疗的患者相比，接受依非韦伦治疗的患者的药房成本较高（8663美元对2846美元，p = 0.0266），但与非依非那韦相关的药房成本较低（2339美元对6628美元，p = 0.0042）。与基于蛋白酶抑制剂的队列相比，基于NNRTI的队列的总成本较低（32,829美元对39,073美元，p = 0.0005），但与整合酶链转移抑制剂队列相比，无显着差异。这项研究提供了与VHA人群中HIV负担相关的新的医疗保健成本和资源利用估算。

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