EVALUATING THE COST OF MEDICATIONS FOR AMBULATORY HIV-INFECTED PERSONS IN ASSOCIATION WITH LANDMARK CHANGES IN ANTIRETROVIRAL THERAPY

Costs of medications for ambulatory HIV-infected people increase as kn owledge of antiretroviral therapy and therapy for opportunistic infect ion grows. We evaluated the evolution of drug costs for HIV-infected p ersons who attend a university clinic in Baltimore, Maryland. Cross-se ctional abstracts of a cohort of patients for four periods, correspond ing to landmark changes in therapy, who attended the clinic between Ju ne 1995 and September 1996 were obtained. Monthly medication costs for all patients were calculated. Mean costs increased significantly (p < .01) from period 1 ($447 U.S.) to period 4 ($1048 U.S.). Multivariate analysis only revealed higher costs for patients with a CD4(+) count <200 cells/mm(3) (p < .001). The proportion of costs attributable to a ntiretroviral therapy increased from 34% in period 1 to 53% in period 4. Combination therapy increased >10-fold, from 8% in period 1 to 94% in period 4. Protease inhibitor use also increased significantly, from 4% in period 2 to 53% in period 4. We quantified the increase in cost s of medications from mid-1995 to late 1996. Increases in costs appear to be the result of increasing complexity of drug regimens, particula rly antiretroviral therapy in combinations.