The effects of HAART on HIV health care provision in the developed world may be entering a new phase according to a report from Yale School of Medicine at the Fourteenth International AIDS Conference in Barcelona today.
New Haven, Connecticut, is one of fifteen American cities where HIV/AIDS is the leading cause of death amongst people aged 25 to 44. In the year 2000, New Haven’s AIDS case rate was 93 per 100,000. This compares to a national US average of 14.3 cases per 100,000.
Doctors from Yale New Haven Hospital, a 900-bed urban teaching hospital, reviewed HIV-related costs and service use during the period between 1995 (just before HAART’s introduction) and 2001. The analysis assessed inpatient and outpatient care costs including staff, laboratory support, X-rays, specialist services, room and board, and other direct and indirect costs. Pharmacy costs were based on Medicaid charges, and the average wholesale price for individual drugs which were prescribed during the study period.
As has been the common experience where HAART has been introduced, inpatient use and the total costs of care fell sharply between 1995 and 1997. Over the following two years, the effects appeared to plateau. In 2000 and 2001, both have increased. Whilst antiretroviral costs have remained relatively stable in more recent years, more patients have received outpatient care, and inpatient utilisation and costs are on the increase.
| Fiscal Year | 10/94-9/95 | 10/95-9/96 | 10/96-9/97 | 10/97-9/98 | 10/98-9/99 | 10/99-9/00 | 10/00-9/01 |
| Inpatient Days | 8790 | 7189 | 5364 | 5073 | 4786 | 5561 | 6292 |
| Inpatient Costs* | $10.1 | $8.5 | $6.5 | $6.1 | $6.4 | $6.9 | $8.1 |
| Antiretroviral Costs* | $1.5 | $2.0 | $4.0 | $5.1 | $5.4 | $6.5 | $6.6 |
| Total Costs* | $14.7 | $13.8 | $14.2 | $15.0 | $15.4 | $17.4 | $18.4 |
* In millions of US dollars
Rawlings J et al. HAART related decline in cost and hospital utilization have reached a plateau. Fourteenth International AIDS Conference, Barcelona, 7-12 July, abstract MoPeB3167, 2002.