498. Cost Effectiveness Analysis of Early vs. Late Diagnosis of HIV-Infected Patients in South Carolina
Session: Poster Abstract Session: HIV Policy and Healthcare Utilization
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Cost of Care Analysis Poster - Updated Version-10-19-16.pdf (966.4 kB)
  • Background: Early HIV diagnosis, and linkage to care leads to improved survival, decreased morbidity and fewer HIV transmissions. This would be expected to lead to a reduction in lifetime cost of care. Yet, previous studies in South Carolina (SC) have shown >40% of HIV diagnoses occur late (CD4 ≤200 cells/mm3 at diagnosis). The aim of this study is to determine the impact of early vs. late diagnosis on the lifetime cost of care.

    Methods: SC HIV/AIDS reporting system (eHARS) data were used for this analysis. This analysis includes individuals with a new diagnosis of HIV in SC from 2013-2015. The first CD4 reported to eHARS was used to categorize early vs. late diagnosis. Late HIV diagnosis was defined as an initial CD4 count ≤200 cells/mm3, early as an initial CD4 >500 cells/mm3. A previously validated simulation model was used to determine the lifetime cost of care (LCC) and quality adjusted life-years (QALYs). Comparisons were made between late and early HIV diagnosis. The Incremental Cost Effectiveness Ratio (ICER), a measure of cost effectiveness based on QALYs saved, was also determined. Previous studies suggest an intervention is cost effective if the ICER is <$100 000 per QALY gained.

    Results: From 2013 – 2015, 1,958 persons were diagnosed with HIV in SC. The overall LCC was $569,633,352.75 ($290,926/person). The table shows the LCC, lost QALYs and HIV transmission per person based on initial CD4 count. Additional life expectancy was 30.7 years for those with initial CD4 ≤200 cells/mm3, 37.2 years with initial CD4 201-500 cells/mm3 and 38.1 years for CD4 >500 cells/mm3. The ICER for diagnosis with an initial CD4 >500 cells/mm3 vs. ≤200 cells/mm3 was $44 112 per QALY gained and for 201-500 vs. ≤ 200 cells/mm3 was $31 947 per QALY gained.

    Table: LCC Stratified by Initial CD4 Count

    Initial CD4

    (cells/mm3)

    N

    LCC/person

    Lost QALY/person

    Transmission/person

    200

    509

    $262,374

    7.95

    1.40

    201-500

    822

    $361,409

    4.85

    1.09

    >500

    627

    $416,766

    4.45

    0.72

    Conclusion: Although individuals with higher initial CD4 counts had a greater LCC, when taking into account QALYs gained, improved life expectancy and decreases in HIV transmission, earlier HIV diagnosis is cost effective. Efforts to increase early testing should improve QALY and decrease HIV transmission leading to downstream cost savings.

    Marlon Rampaul, MBBS1, Babatunde Edun, MD1, Monetha Gaskin, MPH2 and Sharon Weissman, MD1, (1)Infectious Diseases, Palmetto Health Richland USC, Columbia, SC, (2)STD/HIV Division, South Carolina Department of Health and Environmental Control, Columbia, SC

    Disclosures:

    M. Rampaul, None

    B. Edun, None

    M. Gaskin, None

    S. Weissman, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.