COSTS OF HIV+ AIDS AT CD4(+) COUNTS DISEASE STAGES BASED ON TREATMENTPROTOCOLS/

We report treatment protocols for HIV+/AIDS patients by CD4(+) counts (T-lymphocyte cells/mm(3): greater than or equal to 500, 499-200, 199- 50, and <50) as a tool to provide better definition and to project ann ual costs (total charges for services) and lifetimes costs for HIV+/AI DS. The treatment protocols, derived from the literature and an HIV+/A IDS Physician Panel, defined the resource use associated with antiretr oviral therapy and opportunistic disease prophylaxis and treatment. Re source use costs were derived from the published literature, insurance databases, Medicare fee schedules, surveys, and the Physician Panel. At CD4(+) counts, the rates of opportunistic diseases were derived fro m the Physician Panel experience; the mean occupancy times were derive d from the literature. The sensitivity analysis indicated stability of the lifetime costs to variation in mean occupancy times, rates of opp ortunistic diseases, rates of adverse events (AE), and costs. The tota l annual costs (1995 dollars) of HIV+/AIDS patients ranged from $1,934 (greater than or equal to 500), $6,015 (200-499), and $9,031 (50-199) , to $25,239 (<50). The annual costs of opportunistic diseases are eso phageal candidiasis (EC) ($2,194), tuberculosis (TB) ($2,924), cryptoc occal meningitis (CM) ($17,264), toxoplasmosis ($17,631), Mycobacteriu m avium complex (MAC) ($20,153), Non-Hodgkin's lymphoma (NHL) ($22,329 ), wasting syndrome ($26,676), central nervous system (CNS) lymphoma ( $27,333), Pneumocystis carinii pneumonia (PCP) [mild ($3,545), moderat e ($4,889), and severe ($32,609)], Kaposi' sarcoma (KS) [mild/moderate ($5,902), and severe ($10,744)], and cytomegalovirus (CMV) retinitis ($100,337). The projected lifetime costs of HIV+/AIDS are $94,726 (ann ual costs $7,645). Our lower lifetime costs as compared with recent es timates may be due to including resources only for HIV+/AIDS-related t reatment and not for non-HIV+/AIDS conditions, as well as reduced reso urce use resulting from more efficient diagnostic and therapeutic tech niques and earlier prophylaxis provided by experienced HIV+/AIDS physi cians. Nonetheless, our estimates are consistent with decreasing costs of HIV+/AIDS due to a reduction in the average length of stay and fre quency of hospitalizations as well as to replacement of inpatient care by outpatient services.