Comparison of healthcare costs between local and immigrant HIV populations living in Southern Alberta, Canada.

OBJECTIVE

To compare the direct cost of care for Canadian and non-Canadian born HIV patients accessing initial HIV care.

METHODS

Drug, inpatient, and outpatient costs were collected for patients initiating HIV care at the Southern Alberta Clinic between 1/1/2000 and 3/31/2008 and followed until 3/31/2009. Demographic/clinical characteristics were obtained at initial visit. Country of birth determined Canadian (CBP) vs. foreign born (FBP) patients. Costs are mean cost per patient per month (PPPM) in 2009 Cdn$.

RESULTS

Of 281 patients, 103 were FBP. 86% were born in sub-Saharan Africa. FBP were more likely to be female (87% vs. 50%), younger (median 33 vs. 38 years), and heterosexual (93 vs. 35%)(all p<.01) compared to CBP. 74% FBP had CD4<350/mm(3) at initial visit compared to 61% of CBP (p<.05). Subsequent health outcomes for FBP/CBP were similar. Total mean costs PPPM were higher for CBP ($1174 vs. $1067, p<.05), and higher for all CD4 categories primarily due to the costs of non-HIV admissions among CBP injecting drug users (IDU), a risk group not represented within the FBP population of this study. Drugs costs were higher for FBP but lower for inpatient and outpatient costs.

CONCLUSIONS

Once engaged in regular HIV treatment and care, costs and outcomes for FBP were not significantly higher than CBP. Policy decisions concerning FBP with HIV should not be based solely on cost issues.