High long-term economic costs associated with late HIV diagnosis

Late HIV diagnosis is associated with increased healthcare costs in both the short and long-term, Canadian investigators report in the online edition of AIDS.

During the first year after diagnosis, total healthcare costs were almost $ (Canadian) 20,000 per patient for those with a CD4 cell count below 350 cells/mm³, compared  to approximately $8000 per year for patients with higher CD4 cell counts. Even though CD4 cell counts subsequently increased significantly amongst those diagnosed late, their long-term healthcare was still more expensive.

“Recent recommendations for more widespread testing for HIV and earlier initiation of ARV [antiretroviral] therapy at higher CD4 cell counts have not only clinical and public health implications, but may also have an economic impact”, write the investigators.

Current HIV treatment guidelines recommend that antiretroviral therapy should be started when a patient’s has a CD4 cell count of around 350 cells/mm³. However, many patients are diagnosed with CD4 cell counts below this level, and late diagnosis of HIV is the reason underlying much of the HIV-related illness and death that occurs in richer countries.

Research suggests that late HIV diagnosis can involve higher healthcare costs.   This research needs updating as it focused on patients with a CD4 cell count below 200 cells/mm³, well below the current threshold for starting HIV treatment. Moreover, information on the longer-term cost implications of late diagnosis is currently lacking.

Therefore investigators in Alberta, Canada, gathered information on the total costs of treatment and care for 134 patients diagnosed with HIV between 1998 and 2003. At the time of diagnosis 79 (59%) of patients had a CD4 cell count below 350 cells/mm³ and were defined by the investigators as late presenters.

The median CD4 cell count at the time of diagnosis was 134 cells/mm³ for late presenters and 507 cells/mm³ for other patients.

Healthcare costs in the first year after diagnosis averaged at $19, 917 per patient diagnosed late, compared to $7840 for those presenting with higher CD4 cell counts.

For those diagnosed late, 57% of the costs were attributable to antiretroviral and other drugs, 21% to out-patient care, and 22% to in-patient care.

Five years after diagnosis, annual healthcare costs had fallen to $15715 per patient for those diagnosed late and increased to $8863 for each individual diagnosed with a higher CD4 cell count. Most of this increase was due to patients starting HIV treatment, the proportion increasing from 44% in the first year after diagnosis to 71% in year five.

CD4 cell counts were comparable between the two groups of patients by year five (458 vs. 463 cells/mm³). Nevertheless, healthcare costs for late presenters remained 76% higher.

“Aggressive earlier testing programs may generate savings for the entire population in both the short and long term, if higher proportions of individuals are diagnosed and access care at higher CD4 cell counts”, conclude the researchers.