医疗补助患者中与抗逆转录病毒疗法依从性相关的医疗费用。

Healthcare costs associated with antiretroviral adherence among medicaid patients.

作者信息

Pruitt Zachary, Robst John, Langland-Orban Barbara, Brooks Robert G

机构信息

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

出版信息

Appl Health Econ Health Policy. 2015 Feb;13(1):69-80. doi: 10.1007/s40258-014-0138-1.

DOI:10.1007/s40258-014-0138-1

PMID:25403718

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.

摘要

背景

抗逆转录病毒疗法（ART）依从性与医疗补助保险的艾滋病毒或艾滋病患者（PLWHA）的总医疗支出之间的关系尚未得到充分理解，尤其是在无症状艾滋病毒阳性患者中。

目的

本研究对医疗补助保险的艾滋病毒阳性和艾滋病确诊患者群体进行了调查，以确定在24个月的测量期内，ART依从性与平均每月总医疗支出之间的关联，并控制人口统计学、地理、保险和临床因素。本研究通过分别分析无症状艾滋病毒阳性患者与患有艾滋病界定疾病患者的ART依从性与总医疗费用之间的关系，扩展了现有文献。

方法

这项回顾性研究利用了2006年7月至2011年6月佛罗里达医疗补助索赔数据。所有患者（n = 502）均为艾滋病毒阳性，年龄在18 - 64岁之间，非孕妇，且在测量期前至少12个月未接受过ART治疗。根据药物持有率，将每位患者分为依从组（≥90%）或非依从组（<90%），并分为两组：艾滋病毒阳性组（n = 232）和艾滋病确诊组（n = 270）。广义线性模型预测了非依从组与依从组的平均每月总支出。