Cost of medical care for HIV-infected patients within a regional population from 1997 to 2006.

OBJECTIVES: To report on the cost of medical care for HIV-infected patients stratified by CD4 cell count for a regional population over a 9-year period, and to examine the effect of reporting costs of HIV care only or only in antiretroviral therapy (ART)-experienced patients.
METHODS: Retrospective costing analysis on all HIV-infected patients within the Southern Alberta Cohort from April 1997 to April 2006. Costs for all drugs (ART/non-ART), in-patient (HIV/non-HIV) and out-patient care were obtained from primary sources. Costs were aggregated by patient's CD4 cell count and ART exposure and presented as mean cost per patient per month (PPPM) in 2006 Canadian dollars.
RESULTS: The number of patients and annual costs increased by 74% and 69%, respectively. Overall mean PPPM costs increased slightly from $1082 in 1997/1998 to $1159 in 2005/2006. PPPM costs for patients with CD4 counts < or =75 cells/microL increased from $1595 to $2687 while costs for CD4 counts >500, 201-500 and 76-200 cells/microL remained relatively stable at $979, $1057 and $1294, respectively. In-patient hospitalization costs account for most of the cost increases. Reporting costs using only ART-experienced patients would overestimate total costs by 2-9%. Costs for only HIV care were 10-24% lower than total care costs.
CONCLUSIONS: Care costs have remained relatively stable for most HIV patients except those with CD4 counts < or =75 cells/microL. Expensive new antiretroviral drugs have had, at present, a minimal cost impact. Enhanced testing to achieve earlier diagnosis and initiation of highly active antiretroviral therapy could potentially reduce costs of late presentation and in-patient care.