P-231. Healthcare Utilization and Costs in People Living with HIV and Cardiovascular Disease in the United States

TL;DR

People with HIV who also have cardiovascular disease use more healthcare resources and face higher costs compared to those without cardiovascular disease.

Contribution

This study quantifies the increased healthcare utilization and costs among people living with HIV and cardiovascular disease in the US.

Findings

PLWH with CVD had significantly higher healthcare resource utilization and costs compared to those without CVD.

Medical and inpatient costs were 67% and 72.3% higher, respectively, for PLWH with CVD.

Adjusting for comorbidities and demographics, PLWH with CVD had 9% higher total costs.

Abstract

Aging people living with HIV (PLWH) have higher prevalence and increased risk of comorbidities such as cardiovascular disease (CVD). This study assessed incremental all-cause healthcare resource utilization (HCRU) and costs among PLWH with and without CVD in the US.

A retrospective analysis of US administrative claims (Jan 2020-Dec 2022, Optum’s de-identified Clinformatics® Data Mart Database) examined all-cause HCRU and costs among adult (≥ 18 years) PLWH with ≥ 1 pharmacy claim for anchor antiretroviral therapy (ART) agent (NNRTI, PI, or INSTI) in 2021 (index date: earliest anchor ART claim). PLWH were followed to the earliest of 12 months or end of continuous enrollment and stratified into 2 groups based on the presence of CVD (yes/no) during baseline (12 months pre-index) using ICD-10 diagnosis codes from medical claims. Multivariable generalized linear models with negative binomial/Poisson distribution (HCRU) and gamma distribution (costs) estimated differences in all-cause per-patient-per-month (PPPM) HCRU and costs (adjusted to 2023 USD) between groups, adjusting for baseline characteristics.

Of 22,402 PLWH identified, 4,917 (22%) had CVD. PLWH with vs. without CVD were older (mean age 61.45 vs. 52.86 years), more were women (22% vs. 18%) and Black (32% vs. 30%), and had higher mean Quan-Charlson Comorbidity Index scores (2.85 vs. 0.87) and baseline total costs ($5,574 vs. $3,442); all p < 0.001. Unadjusted all-cause PPPM HCRU and costs were significantly higher in PLWH with vs. without CVD (all p < 0.001; Table). In multivariable analyses, PLWH with vs. without CVD had significantly greater all-cause PPPM HCRU, total costs (9% higher), medical costs (67% higher), and inpatient costs (72.3% higher) (all p < 0.001; Table).

PLWH with CVD experience a greater HCRU and cost burden than those without CVD. Identifying modifiable CVD risk factors (e.g., hypertension, type 2 diabetes mellitus) along with providing individualized HIV care might mitigate increases in HCRU and costs while optimizing care for PLWH.

Sean P. Fleming, PhD, MSW, Merck & Co., Inc., Rahway, NJ, USA: Employee|Merck & Co., Inc., Rahway, NJ, USA: Stocks/Bonds (Public Company) Shweta Kamat, MS, PhD, Merck & Co., Inc., Rahway, NJ, USA: Contracted research Girish Prajapati, M.B.B.S., MPH , Merck & Co., Inc.: Employee|Merck & Co., Inc.: Stocks/Bonds (Private Company) Viktor Chirikov, MS, PhD, Merck & Co., Inc., Rahway, NJ, USA: Contracted research Wenying Quan, MS, Merck & Co., Inc., Rahway, NJ, USA: Contracted research Mark Bounthavong, PharmD, PhD, Merck & Co., Inc., Rahway, NJ, USA: Consultant|University of California, San Diego: Employment

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