1241. Earlier HIV Diagnosis Leads to Significantly Decreased Costs in the First Two Years of HIV Care in an Urban Charity Hospital in New Orleans
Session: Oral Abstract Session: HIV: Detection, Linkage, and Utilization
Saturday, October 5, 2013: 11:18 AM
Room: The Moscone Center: 250-262
Background:

Multiple studies have shown that early detection and treatment of HIV improves clinical outcomes.  However, early detection and linkage to care will increase the number of HIV patients receiving medical care and could result in increased costs.  The purpose of this study was to determine if early detection of HIV can result in cost savings in a system with limited resources.

Methods:

A retrospective cost analysis was conducted using the medical records of patients who had a positive rapid HIV test in the emergency department in 2008 and were then linked to care. Inpatient, outpatient, and emergency costs as well as number of visits were collected for the first 2 years after initial HIV diagnosis.  SAS was used for analysis. Data were analyzed using the Kruskal-Wallis (KW) test to determine if there were differences in costs among the CD4 count categories (<200, 200-349, 350-499, >499) at initial diagnosis.  Significant KW results were supplemented by assessing pair wise differences with a Bonferroni correction to adjust for multiple comparisons.  The Jonckheere-Terpstra test (JT) was used to assess linear trend.

Results:

Fifty-six patients met the inclusion criteria; they were predominantly uninsured (73%) and African-American (89%).  The median total bill for a newly diagnosed patient over the first two years was $36,808 or $18,404 per year, driven predominantly by outpatient costs, $17,512 or $8,756 per year.  The median amount recovered from insurance payments was $1,694 or $847 dollars a year.  Median inpatient and total costs were significantly different between the lowest (<200) and highest (>499) CD4 count categories ($21,878 vs. $6,607, p<0.05; $61,378 vs. $18,837, p<0.05, respectively).  Total costs demonstrated a significant linear trend between all CD4 count categories (p<0.05 JT).  Outpatient costs trended towards lower costs for the highest CD4 count category but were not significant ($12,850 vs. $18,419, p 0.19).                   

Conclusion:

Total costs were significantly lower among patients diagnosed earlier in their disease.  Those with lower CD4 counts (<200) had three times the median costs as those with higher CD4 counts (>499) in the first two years, driven predominantly by inpatient costs.  Decreased cost is another factor supporting early diagnosis and linkage to care for patients with HIV.

Jason Halperin, MD, MPH1, Ishani Pathmanathan, MD, MPH2, Morgan Katz, MD3, Leann Myers, PhD4,5, Nicholas Van Sickels, MD6, Paula Seal, MD, MPH7 and Lauren Richey, MD, MPH6, (1)Internal Medicine, Tulane University Medical Center, New Orleans, LA, (2)Tulane University Medical Center, New Orleans, LA, (3)Internal Medicine, Tulane University Hospital, New Orleans, LA, (4)Biostatistics & Bioinformatics, Tulane University, New Orleans, LA, (5)Department of Biostatistics & Bioinformatics, Tulane University, New Orleans, LA, (6)Infectious Diseases Section, Tulane University, New Orleans, LA, (7)Infectious Diseases Section, Louisiana State University Health Sciences Center, New Orleans, LA

Disclosures:

J. Halperin, None

I. Pathmanathan, None

M. Katz, None

L. Myers, None

N. Van Sickels, None

P. Seal, None

L. Richey, None

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