Expenditures for the care of HIV-infected patients in the era of highly active antiretroviral therapy.

Background: The introduction of expensive but very effective antiviral medi cations has led to questions about the effects on the total use of resource s for the care of patients with human immunodeficiency virus (HIV) infectio n. We examined expenditures for the care of HIV-infected patients since the introduction of highly active antiretroviral therapy. Methods: We interviewed a random sample of 2864 patients who were represent ative of all American adults receiving care for HIV infection in early 1996 , and followed them for up to 36 months. We estimated the average expenditu re per patient per month on the basis of self-reported information about ca re received. Results: The mean expenditure was $1,792 per patient per month at base line , but it declined to $1,359 for survivors in 1997, since the increases in p harmaceutical expenditures were smaller than the reductions in hospital cos ts. Use of highly active antiretroviral therapy was independently associate d with a reduction in expenditures. After adjustments for the interview dat e, clinical status, and deaths, the estimated annual expenditure declined f rom $20,300 per patient in 1996 to $18,300 in 1998. Expenditures among subg roups of patients varied by a factor of as much as three. Pharmaceutical co sts were lowest and hospital costs highest among underserved groups, includ ing blacks, women, and patients without private insurance. Conclusions: The total cost of care for adults with HIV infection has decli ned since the introduction of highly active antiretroviral therapy. Expendi tures have increased for medications but have declined for other services. However, there are large variations in expenditures across subgroups of pat ients. (N Engl J Med 2001;344:817-23.) Copyright (C) 2001 Massachusetts Med ical Society.