The high cost of medical care for patients who present late (CD4<200 cells/μL) with HIV infection

OBJECTIVE: To compare the direct costs of medical care in the year following HIV diagnosis for patients who present with a CD4 count 200 cells/microL ('early presenters'). METHODS: Direct costs (i. e. drugs, laboratory tests, outpatient care, in-patient care, and home care) for the 12 months following HIV diagnosis, sociodemographic data and clinical data were collected for all patients presenting for HIV care in Southern Alberta, Canada between April 1996 and April 2001. Mean costs are presented as costs in 2001 Canadian dollars. RESULTS: Thirty-nine per cent of 241 patients presented with a CD4 count <200 cells/microL. The mean costs for late presenters were more than twice as high as those for early presenters (i. e. 18, 448 vs. 8455, respectively). Late presenters were more likely to be older, male and black, and to have a risk activity of men having sex with men (MSM) or heterosexual contact (P<0. 05). However, the large difference in mean costs cannot be attributed to differences in characteristics. When characteristics were statistically held constant, the estimated excess cost of late presentation was almost unaffected, at 9723 (z=5. 6). Repeating the analysis using disaggregated costing categories suggested that the difference in total costs was largely attributable to differences in HIV-related hospital care costs, which were 15 times higher for late presenters. CONCLUSIONS: Direct care costs in the year following HIV diagnosis were more than 200% higher for patients who presented late. This difference could not be attributed to differences in patient characteristics. Most costs were attributable to HIV-related hospital care costs and the immediate initiation of antiretroviral therapy. While early diagnosis in those at risk for HIV remains medically important, the short-term economic impact is also substantial.