Healthcare costs associated with antiretroviral adherence among medicaid patients

Healthcare resource utilization and related cost of non-HIV comorbidity management in people with HIV in a Spanish cohort from 2007-2016

OBJECTIVE

To estimate the cost and healthcare resource utilization (HRU) associated with the prevalence of comorbidities in people living with HIV (PLWH) in a Spanish cohort over ten years.

METHODS

A cohort study carried out at the HIV outpatient clinic of the University Hospital Virgen del Rocío based on data collected during 2007-2016. PLWH with at least one follow-up visit were included. Comorbidities were determined by examining diagnostic codes in the electronic medical records. Costs were estimated from hospitalizations, emergency and non-HIV visits, laboratory tests for conditions unrelated to HIV infection, HIV antiretroviral therapy, and other non-HIV diagnostic tests. A linear regression was performed with non-ART costs as the dependent variable and patient characteristics (sex, HIV transmission route, age, CD4, comorbidities, and infection duration) as independent variables.

RESULTS

The study included 2,798 PLWH; 83% were men with a mean age of 38.6 years. Overall, 52.5% of PLWH had at least one non-HIV comorbidity and 21.2% had ≥3 comorbidities. The most prevalent comorbidities were hepatitis C (25.3%) and hypertension (22.9%). The presence of comorbidities increased the total healthcare cost up to 80% in PLWH with ≥3 comorbidities compared with those without comorbidities (over a 10-year period (115,867.3€ vs 64,290.7€, p < .001). The number of comorbidities was linked to higher healthcare costs in PLWH in the adjusted model.

CONCLUSION

Comorbidities raised the total healthcare costs for PLWH, with a greater impact on those with multiple comorbidities compared to those with few or none. Both clinical and economic decision-makers must consider and assess the cost of comorbidities when evaluating HIV treatment guidelines or recommendations.

Pattern of Medication Adherence, Spirituality and Viral Load amongst Adult Patients on Highly Active Antiretroviral Therapy in Rural Southwest Nigeria

INTRODUCTION

Previous studies have been conducted on medication adherence in Southwest Nigeria, but none of these has reported the relationship between highly active antiretroviral therapy (HAART) adherence, spirituality and viral load (VL) amongst people living with Human immunodeficiency virus (HIV)/AIDS, especially in rural settings of Southwestern Nigeria. This study assessed the pattern of medication adherence, spirituality and VL and ascertained the association of socio-demographics and spirituality on medication adherence amongst patients on HAART in rural Southwestern Nigeria.

MATERIALS AND METHODS

A hospital-based cross-sectional study involving 321 consented patients on HAART who were recruited by systematic sampling technique at the adult HIV clinic. Data were collected using an interviewer-administered questionnaire that assessed participants' socio-demographic profiles, medication adherence and spirituality. Their blood samples were collected and their VLs were determined. The data were analysed using SPSS version 20. Logistic regression was done to identify the independent predictors of medication adherence.

RESULTS

The majority of the respondents reported a medium level of medication adherence (66.4%), a high level of spirituality (68.8%) and a low level of VL (67.3%). Amongst variables that had a statistically significant association with medication adherence were being educated, married, divorced, separated or widowed (P < 0.05). Furthermore, persons with high spirituality were 2.6 times more likely to be adherent to antiretroviral drugs when compared to persons with low spirituality (P < 0.05).

CONCLUSION

It was shown that high spirituality is a positive predictor of medication adherence amongst patients on HAART. It, therefore, suggests that efforts deployed to improve the spirituality of these patients would most likely improve their medication adherence.

Real-World Health Plan Data Analysis: Key Trends in Medication Adherence and Overall Costs in Patients with HIV

BACKGROUND

Adherence to effective antiretroviral therapy (ART) is essential to achieve long-term viral suppression in patients with HIV-1. Single-tablet regimens (STRs) have improved adherence and decreased health care costs and hospitalizations, but previous study results suggest that the relationship between ART adherence and health care costs and utilization is complex.

OBJECTIVE

To assess ART adherence trends in patients with HIV-1 to determine if differences in utilization, demographics, and overall costs exist among patients with varying levels of medication adherence.

METHODS

This retrospective study analyzed medical and pharmacy claims data from an administrative claims database between January 1, 2007, and June 30, 2016, for Medicaid or commercially insured patients continuously enrolled for ≥ 6 months before and ≥ 15 months after the index date (date of first medical claim with an HIV diagnosis or pharmacy claim for HIV ART medication between July 1, 2007, and June 30, 2014). Qualifying patients were aged ≥ 18 years with a diagnosis of HIV-1 infection or at least 1 pharmacy claim for HIV ART at index and at least 2 pharmacy claims during the follow-up period. Patients were categorized on the basis of adherence as measured by proportion of days covered (PDC; ≥ 95%, highly adherent; < 95%, less adherent) and treatment with an STR or multiple-tablet regimen (MTR). Commercially insured patients were stratified by duration of follow-up data (< 3 or ≥ 3 years). There were not enough Medicaid patients for follow-up analysis. Outcomes of interest were ART adherence and annual medical and pharmacy utilization and costs. Descriptive statistics were generated, and health care resource utilization and costs were reported as annual averages. Chi-square and t-tests were used to examine differences between the cohorts.

RESULTS

A total of 332 Medicaid patients and 1,698 patients insured commercially met inclusion criteria. Adherence to ART medication (mean PDC) during the first 15 months was lower in Medicaid patients (65%) versus commercial patients (79%; P < 0.0001). Patients treated with STRs comprised 47% and 37% of patients in the < 3-year and ≥ 3-year follow-up cohorts, respectively. More STR patients achieved ≥95% adherence than MTR patients (< 3-year follow-up, 53% vs. 39%; ≥ 3-year follow-up, 61% vs. 45%; P < 0.001). In both follow-up cohorts, less adherent patients had higher mean annual medical costs, and results were significant for patients with ≥ 3-year follow-up ($8,224 vs. $3,097; P = 0.0007). These results were largely driven by savings in mean annual inpatient costs among the highly adherent patients in both cohorts (< 3-year follow-up, -$2,525 [P = 0.0003]; ≥ 3-year follow-up, -$815 [P < 0.001]).

CONCLUSIONS

Patients on STRs were more adherent than patients on MTRs regardless of length of follow-up. Better adherence was associated with significant inpatient cost savings. The relationship between adherence and total medical costs is nuanced depending on the duration of follow-up.

DISCLOSURES

This study was funded by ViiV Healthcare, which participated in protocol development, the analysis plan, and interpretation of results but did not have final approval on the decision to publish. Kangethe, Polson, Lord, and Evangelatos are employees of Magellan Rx Management, which was contracted by ViiV Healthcare to conduct the research for this study. Oglesby is an employee of ViiV Healthcare and owns stock in GlaxoSmithKline. Data from this study were previously presented at AMCP Nexus; October 16-19, 2017; Dallas, TX.

Economic impact of medication non-adherence by disease groups: a systematic review

OBJECTIVE

To determine the economic impact of medication non-adherence across multiple disease groups.

DESIGN

Systematic review.

EVIDENCE REVIEW

A comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist.

RESULTS

Seventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to 'all causes' non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents.

CONCLUSION

Medication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required.

PROSPERO REGISTRATION NUMBER

CRD42015027338.

In Four ACA Expansion States, The Percentage Of Uninsured Hospitalizations For People With HIV Declined, 2012-14

This study examines the influence of the Affordable Care Act's optional state Medicaid expansion on insurance coverage and health outcomes for hospitalized patients with HIV. I used data from the State Inpatient Databases of the Healthcare Cost and Utilization Project for all hospitalizations of patients with HIV from 2012 through the first six months of 2014 in four states that expanded their Medicaid programs and two states that did not. I found that the percentage of hospitalizations of uninsured people with HIV in the four expansion states fell from 13.7 percent to 5.5 percent in the study period, while the percentage in the two nonexpanding states increased from 14.5 percent to 15.7 percent. I also found that hospitalized patients with HIV who did not have insurance were 40 percent more likely to die during their hospital stays than comparable patients with insurance.

Correlates of Combination Antiretroviral Adherence Among Recently Diagnosed Older HIV-Infected Adults Between 50 and 64 years

Optimal adherence to combination antiretroviral therapy is essential to the health of older people living with HIV (PLWH), however, the literature on adherence and aging is limited. Using Medicaid data from 29 states (N = 5177), we explored correlates of optimal adherence among older PLWH. The prevalence of optimal adherence was low (32 %) in this study. Males were more adherent than females (APR = 1.11, 95 % CI 1.02-1.21, P = 0.0127); persons with three or more co-morbidities (APR = 0.67, 95 % CI 0.60-0.74, P < 0.001), two co-morbidities (APR = 0.86, 95 % CI 0.75-0.98, P = 0.0319) and one co-morbidity (APR = 0.82, 95 % CI 0.73-0.92, P = 0.0008) were less adherent than those without any co-morbidity; and residents of rural areas (APR = 0.90, 95 % CI 0.63-0.98, P = 0.0385) and small metropolitan areas (APR = 0.82, 95 % CI 0.72-0.94, P = 0.0032) were less adherent than residents of large metropolitan areas. There were no racial differences in optimal adherence. Targeted interventions that provide adherence support, case management, and peer navigation services may be of benefit in achieving optimal adherence in this population.