Overview
HIV
HCV

Overview

The healthcare cost of HIV and Hepatitis C were identified through the creation of a model of service delivery reflecting current practice by the authors, who included doctors experienced in HIV and HCV. Utilisation data was derived for different health states from the literature and local data by four CD4 strata in HIV and by seven disease states in HCV.

HIV

Identification

The following items of service were identified for people living with HIV: Medical consultations including general practitioners and specialists; Allied Health including psychologists, social workers and dietician; Pathology including Full Blood Examination, CD4 T-cell Lymphocyte phenotype, HIV viral load, blood chemistry including liver enzymes, creatinine, urea, electrolytes, glucose, genotype resistance testing; inpatient hospitalisations; Medications including prophylaxis and associated non-ARV medications. These items were similar to those identified in a pre-ARV era study of Australian health service use by Hurley.231, 232

Utilisation

The utilisation of each type of service was determined from published data and clinical experience of the authors. Utilisation was the incremental use of health services over and above the use by people of a similar age and gender without HIV. People living with HIV were divided into four health states according to CD4 T cell count >500, 350-499, 200-349 and >200. Antiretroviral costs were calculated separately.

50% of patients are seen by their general practitioner for HIV care in the HIV Futures 5 study.233 In a study in the United States people with HIV visited outpatients five times a year234 and in Italy five to six times;235 in another study in the USA, patients were seen 9.7 times;236 all studies showed that utilisation rose with lower CD4 cell counts with 20% more visits when the CD4 was less than 350.237 In contrast, males in the overall Australian population aged 25-45 years claimed two to three standard GP consultations in a year.238, 239 8% of people used a clinical psychologist for counselling, 10% saw a social worker and 5% saw a dietician. Pathology utilisations followed a standard three monthly monitoring for people with a CD4 cell count greater than 500, with a proportion having a genotype resistance test in a year. Medications for prophylaxis of herpes simplex virus, mycobacterium complex and pneumocystis pneumonia commenced when the CD4 cell count was low.
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According to epidemiological data, the risk of AIDS is low with higher CD4 cell counts234 but people may be admitted with serious non-AIDS events. Hospitalisation was rare (1%) in Italy with high CD4 cell counts235, 240 but higher (11%) in the USA;234, 235, 240, 241 hospitalisation risk increased in all settings with lower CD4 cell counts.44 A national hospital admissions database was searched to determine the types of admission with HIV as a primary or secondary diagnosis in Australia by diagnostic related group(DRG).42 The assumptions on use of medical and pathology services were consistent with unpublished data from a study of Medicare Benefits Schedule claims by people with HIV 2003-2007 (n=10951) (Anderson unpublished data).

Valuation

Outpatient items were valued from the Medicare Benefits Schedule,43 Prescription Benefits Schedule,242 the Pharmaceutical Benefits Advisory Committee Manual of Resource Items and the Department of Veteran Affairs in 2008 dollars. The unit costs of inpatient admission were estimated by using the proportions of admissions for each type of DRG and the public hospital cost-weights for DRGs, to create a weighted average cost per admission with HIV.

Antiretrovirals

Use of antiretrovirals was determined by clinical advice from one of the authors (JA), an experienced HIV physician and was consistent with the Australian commentary on the US DHHS guidelines43 with three lines of antiretroviral therapy. Patients were assumed to start ARVs when their CD4 cell count was less than 350 and continue on them indefinitely. In the population model they moved to the next line of therapy when the previous one failed. Antiretrovirals were valued by the Prescription Benefits Schedule.243

Patient/carer healthcare costs associated with HIV infection where CD4>500

DescriptionNumber per yearUnit cost% of patients havingCost per patientRationale/Comment
General-practitioner consultations
5
$33.55
50%
$82.00
Item 23
Specialist consultations
5
$69.75
50%
$145.00
Item 116
Clinical Psychologist
12
$119.75
8%
$114.96
CL01 One hour
Social Worker
2
$57.55
10%
$11.51
SW01 One hour
Dietician
2
$80.30
5%
$8.03
DT01 One hour
FBE
4
$17.20
100%
$51.60
Item 66515
CD4 T cell lymphocyte count
4
$105.85
100%
$317.60
Included in item 66515
HIV viral load
4
$181.45
100%
$544.40
Liver enzymes/renal
4
$17.80
100%
$59.40
Glucose/lipids
1
$0.00
100%
$14.85
Included in item 66500
Resistance test
1
$600.00
10%
$60.00
10-20% viral failure/year
Hospitalisations
1
$7,245.40
1%
$114.00
CD4 >500 total cost per year
$1,523.35
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Patient/carer healthcare costs associated with HIV infection where 350<CD4<500

DescriptionNumber per yearUnit cost% of patients havingCost per patientRationale/Comment
General-practitioner consultations
5
$33.55
50%
$82.00
Item 23
Specialist consultations
5
$69.75
50%
$145.00
Item 116
Clinical Psychologist
12
$119.75
8%
$114.96
CL01 One hour
Social Worker
2
$57.55
10%
$11.51
SW01 One hour
Dietician
2
$80.30
5%
$8.03
DT01 One hour
FBE
5
$17.20
100%
$64.50
CD4 T cell lymphocyte count
5
$105.85
100%
$397.00
HIV viral load
5
$181.45
100%
$680.50
Item 66515
Liver enzymes/renal
5
$17.80
100%
$74.25
Included in item 66515
Glucose/lipids
1
$14.85
100%
$14.85
Resistance test
1
$600.00
20%
$120.00
Hospitalisations
1
$7,245.40
3%
$342.00
CD4 350-499 total cost per year
$2,054.60

Patient/carer healthcare costs associated with HIV infection where 200<CD4<349

DescriptionNumber per yearUnit cost% of patients havingCost per patientRationale/Comment
General-practitioner consultations
7
$33.55
50%
$114.80
Item 23
Specialist consultations
7
$69.75
50%
$203.00
Item 116
Clinical Psychologist
12
$119.75
8%
$114.96
CL01 One hour
Social Worker
2
$57.55
10%
$11.51
SW01 One hour
Dietician
2
$80.30
5%
$8.03
DT01 One hour
FBE
6
$17.20
100%
$77.40
CD4 T cell lymphocyte count
6
$105.85
100%
$476.40
HIV viral load
6
$181.45
100%
$816.60
Item 66515
Liver enzymes/renal
6
$17.80
100%
$89.10
Included in item 66515
Glucose/lipids
1
$14.85
100%
$14.85
Resistance test
1
$600.00
20%
$120.00
Hospitalisations
1
$7,245.40
6%
$684.00
CD4 200-349 total cost per year
$2,730.65
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Patient/carer healthcare costs associated with HIV infection where CD4<200

DescriptionNumber per yearUnit cost% of patients havingCost per patientRationale/Comment
General-practitioner consultations
8
$33.55
50%
$131.20
Item 23
Specialist consultations
5
$69.75
50%
$145.00
Item 116
Clinical Psychologist
12
$119.75
8%
$114.96
CL01 One hour
Social Worker
2
$57.55
10%
$11.51
SW01 One hour
Dietician
2
$80.30
5%
$8.03
DT01 One hour
FBE
6
$17.20
100%
$0.00
CD4 T cell lymphocyte count
6
$105.85
100%
$476.40
HIV viral load
5
$181.45
100%
$680.50
Liver enzymes/renal
6
$17.80
100%
$89.10
Covered in 66512
Glucose/lipids
1
$0.00
100%
$14.85
Covered in 66512
Resistance test
1
$600.00
50%
$300.00
Non-ARV medications - Cotrimoxazole
52
$8.93
100%
$331.92
Prophylaxis for PCP
Non-ARV medications - Valtrex /Famvir
12
$213.63
100%
$1,853.40
Non-ARV medications - Azithromycin
6
$67.82
50%
$203.46
50% will need it as CD4<100
Hospitalisation
1
$7,245.40
10%
$1,140.00
Hospitalisation
1
$7,245.40
3%
Hospitalisation
1
$7,245.40
50%
CD4<200 total cost per year
$5,500.33

Diagnostic Related Groups for HIV admissions

DRG Code v5 DRG Description No. % of totalAverage cost per admission
S65CHIV-Related Diseases-Cscc
152
4.45%
$5,998
S65BHIV-Related Diseases+Scc
151
4.42%
$8,862
S65AHIV-Related Diseases+Ccc
128
3.75%
$20,793
S60Z HIV, Sameday
58
1.70%
$721
T63B Viral Illness A<60-Cc
4
0.12%
$1,098
T63A Viral Illness A>59/+Cc
1
0.03%
$2,044
TO1COr Proc Infect & Paras Dis-Cc
1
0.03%
$5,028
S60Z HIV, Sameday
896
26.23%
$721
S65CHIV-Related Diseases-Cscc
564
16.51%
$5,998
S65AHIV-Related Diseases+Ccc
497
14.55%
$20,793
S65BHIV-Related Diseases+Scc
450
13.17%
$8,862
Q62Z Coagulation Disorders
174
5.09%
2,555
G11AAnal & Stomal Procedures+Cscc
81
2.37%
6,423
G44COther Colonoscopy, Sameday
70
2.05%
1,177
F74Z Chest Pain
66
1.93%
1,474
X62APoisng/Toxc Eff Drugs A>59/+Cc
62
1.81%
3,651
G45BOther Gastrpy+N-Mjr Digest Dis
61
1.79%
1,047
Total
3416
100.00%
$7,245.40
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Cost of ARC medications

The table 'Cost of ARC medications' is separated into 3 smaller tables in this HTML version for accessibility reasons. It is presented as one table in the PDF version.

First line SOC

MedicationNumber per yearUnit costCost per year
Truvada
12
$765.10
$9,181.20
Efavirenz
12
$452.64
$5,431.68
Total first line SOC
$14,612.88

Second line SOC

MedicationNumber per yearUnit costCost per year
NRTI Abacavir
12
$423.00
$5,076.00
NRTI
12
$282.00
$3,384.00
Atazanavir
12
$521.91
$6,262.92
Boosting Ritonavir
12
$37.92
$455.01
Total second line SOC
$15,177.93

Third line

MedicationNumber per yearUnit costCost per year
Kaletra
12
$685.00
$8,220.00
Raltegravir
12
$1,146.60
$13,759.20
Etravirine
12
$483.10
$5,797.20
Total third line
$27,776.40
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HCV

Patient/carer healthcare costs for HCV

The following outlines the patient/carer healthcare costs associated with HCV infection.

Cost of HCV-related outcomes:
  • Chronic HCV - $2,827
  • Cirrhosis - $4,212
  • Treatment - $4,426
  • Hepatocellular carcinoma - $7,400
  • Transplant - $13,665
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