Pediatric HIV Costs Across Three Treatment Eras from 1986 to 2007

OBJECTIVE: Life has changed dramatically for infants exposed perinatally to HIV to HIV primarily because of a successful translational research program that has also affected treatment costs. We compared treatment costs among HIV⁺ patients in an HIV/AIDS specialty clinic across 3 treatment eras: monotherapy (pre-1990), combination therapy (1990-1996), and highly active antiretroviral therapy (HAART) (1997-2007). We also estimated cumulative health care costs among pediatric HIV/AIDS patients born in each era. PATIENTS AND METHODS: Data on health care use were collected from medical records of 126 infants born to HIV⁺ mothers during a 21-year period (1986-2007) (728 person-years). The Drug Topics Red Book 1999 was used for drug costs, the Current Procedural Terminology Medicare Fee Schedule codes for outpatient costs, and the Healthcare Cost and Utilization Project Kids' Inpatient Database for inpatient costs. Generalized estimating equations and bootstrapped ordinary least-squares models were used to determine 2007 costs, cumulative costs, and cost savings. RESULTS: Lifetime cost savings with HAART were $6.7 to $23.3 million, depending on incidence. Average total costs per HIV ⁺ person per month were $1306 ($318 for drugs, $896 for total medical) in the monotherapy era, $2289 ($891 for drugs, $1180 for total medical) in the combination-therapy era, and $1814 ($1241 for drugs, $320 for total medical) in the HAART era. Total costs during the HAART era were 25.2% lower than costs during the combination-therapy era, because the 34% higher HAART drug costs were compensated for by total medical costs (inpatient + outpatient) that were 57% lower, which was a significant change (P < .001). The cumulative costs for treatment of an HIV⁺ patient were highest during the monotherapy era ($196 860) and lowest during the HAART era ($181 436). CONCLUSIONS: Our results show that the cost burden for the treatment of HIV ⁺ pediatric patients has decreased over time. This historical examination of treatment-era costs demonstrates the value of technologic advances in treatment.