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Healthcare Costs Associated with Antiretroviral Adherence Among Medicaid Patients

  • Original Research Article
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Abstract

Background

The relationship of antiretroviral therapy (ART) adherence to total healthcare expenditures for Medicaid-insured people living with HIV or AIDS (PLWHA) is not well understood, especially among asymptomatic HIV-positive patients.

Objective

This study examined Medicaid-insured HIV-positive and AIDS-diagnosed patient groups to determine the association of ART adherence to mean monthly total healthcare expenditures in the 24-month measurement period, controlling for demographic, geographic, insurance, and clinical factors. The present study extends the existing literature by analyzing the relationship of ART adherence to total healthcare costs for asymptomatic HIV-positive patients separately from those patients with AIDS-defining conditions.

Methods

This retrospective study utilized claims data from Florida Medicaid claims from July 2006 through June 2011. All patients (n = 502) were HIV-positive, aged 18–64 years, non-pregnant, and ART naïve for at least 12 months prior to the measurement period. Each patient was categorized, based on medication possession ratios, as adherent (≥90 %) or non-adherent (<90 %), and were divided into two groups: HIV positive (n = 232) and AIDS diagnosed (n = 270). Generalized linear models predicted the mean monthly total expenditures for the non-adherence group versus the adherence group.

Results

For the HIV-positive group, the adjusted mean monthly expenditures for the non-adherent group were US$1,291; the adherent group adjusted mean monthly expenditures were US$1,926. The HIV-positive non-adherent group adjusted mean monthly expenditures were significantly less than the adherent group (−40 %, p < 0.001). However, for the AIDS-diagnosed group, there was not a statistically significant association of ART adherence to total healthcare expenditures (p = 0.29).

Conclusion

The results show that the relationship of ART adherence to healthcare costs is more complex than previously reported.

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Acknowledgments

The contributions of John Large, Ph.D. and Sheri Eisert, Ph.D. on an earlier version of this paper are gratefully acknowledged. The authors had no conflicts of interest related to this paper, and had no funding for this research.

Author contribution

ZP developed the hypothesis. ZP, JR, BLO, and RB laid out the methodology for testing the hypothesis. ZP and JR provided statistical analysis. ZP developed the first draft of the manuscript. ZP, JR, BLO, and RB edited and revised the final draft of the manuscript. ZP is the guarantor for the overall content.

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Authors and Affiliations

  1. College of Public Health, Health Policy and Management, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612-3805, USA

    Zachary Pruitt, Barbara Langland-Orban & Robert G. Brooks

  2. Florida Mental Health Institute, University of South Florida, Tampa, USA

    John Robst

Authors
  1. Zachary Pruitt
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  2. John Robst
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  3. Barbara Langland-Orban
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  4. Robert G. Brooks
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Corresponding author

Correspondence to Zachary Pruitt.

Additional information

Robert G. Brooks was formerly affiliated with the University of South Florida, Morsani College of Medicine and College of Public Health, Health Policy and Management, Tampa, FL, USA.

Appendix

Appendix

See Tables 8 and 9.

Table 8 Generalized linear model (gamma, log link) for total healthcare costs in a 24-month period among Medicaid-insured previously antiretroviral therapy-naïve HIV-positive patients (n = 232)
Full size table
Table 9 Generalized linear model (gamma, log link) for total healthcare costs in a 24-month period among Medicaid-insured previously antiretroviral therapy-naïve AIDS-diagnosed patients (n = 270)
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Pruitt, Z., Robst, J., Langland-Orban, B. et al. Healthcare Costs Associated with Antiretroviral Adherence Among Medicaid Patients. Appl Health Econ Health Policy 13, 69–80 (2015). https://doi.org/10.1007/s40258-014-0138-1

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