Adherence Cuts Health Costs?

High antiretroviral therapy adherence, which has been shown to be a major predictor of HIV disease progression and survival, is now associated with lower health care costs, according to researchers at the Johns Hopkins Bloomberg School of Public Health.

Researchers examined the effect of antiretroviral therapy adherence on direct health care costs and found that antiretroviral therapy improves health outcomes for people infected with HIV, saving a net overall median monthly health care cost of $85 per patient. The results are featured in the January 5 issue of the Annals of Internal Medicine.

"Our analysis found that greater antiretroviral therapy adherence was associated with lower direct health care costs for HIV-infected adults who received care through a large HIV disease management program in South Africa," says Jean B. Nachega, MD, Ph.D., MPH, lead author of the study and an associate scientist in the Bloomberg School's department of international health. "Cost for hospitalization increased from 29% to 51% of total costs as antiretroviral therapy adherence decreased, and this increase explains the difference in total mean monthly heath care costs from the lowest to the highest antiretroviral therapy adherence quartile."

Researchers conducted a cohort study to determine the effect of antiretroviral therapy adherence on direct health care costs among 6,833 HIV-infected adults. Study participants were enrolled in Aid for AIDS, a private-sector HIV-management program in South Africa between 2000 and 2006. Nachega, along with colleagues from the Bloomberg School, University of Cape Town, and Aid for AIDS, averaged monthly direct health care costs and categorized pharmacy claim adherence in quartiles (from one to four). Independent effects of patient characteristics on monthly total health care costs were assessed.

"The cost savings are largely related to less hospital use. The threat is that budgets for hospitals are often divorced from budgets for outpatient AIDS treatment. In fragmented health systems it is difficult for the outpatient administrator to rationalize investments that lower the costs for hospitals. A broader view is necessary to improve patient care and save money," says David Bishai, MD, Ph.D., coauthor of the study and an associate professor in the Bloomberg School's department of population, family, and reproductive health.

"Effective, practical intervention strategies to promote -- as well as to proactively monitor antiretroviral therapy adherence -- are badly needed, since they may save direct health care costs by decreasing patient's morbidity and mortality and are likely to be cost-effective in the long-term," adds Nachega.