Incremental healthcare resource utilization and costs among people living with HIV with and without cardiovascular disease, hypertension, and type 2 diabetes mellitus in the United States.

OBJECTIVE

To assess incremental all-cause healthcare resource utilization (HCRU) and costs among people living with HIV (PLWH) with and without cardiovascular disease (CVD), hypertension, or type 2 diabetes mellitus (T2DM) in the United States (US).

METHODS

This retrospective US administrative claims analysis (Jan 2020-Dec 2022, Optum's de-identified Clinformatics Data Mart Database) included adult PLWH with ≥1 pharmacy claim for anchor antiretroviral therapy (ART) in 2021 (index date: earliest anchor ART claim). PLWH were followed for 12 months or to end of continuous enrollment and stratified based on baseline presence of CVD (yes/no), hypertension (yes/no), or T2DM (yes/no). Differences between groups in all-cause per-person-per-month (PPPM) HCRU and costs (adjusted to 2023 USD) were estimated using multivariable generalized linear models with negative binomial (HCRU) or gamma (cost) distributions, adjusting for baseline characteristics. HIV-specific and comorbidity-specific HCRU and cost models are not reported due to non-convergence.

RESULTS

Of 22,402 PLWH identified, 4,917 (21.9%) had CVD, 10,878 (48.6%) hypertension, and 4,562 (20.4%) T2DM. PLWH with versus without the selected comorbidities were older, more likely to be women or Black, and had higher mean Quan-Charlson Comorbidity Index scores and baseline total costs (all p <.001). They also had higher adjusted all-cause PPPM total costs (CVD: +9% [+$614]; hypertension: +2% [+$168]; T2DM: +12% [+$773]), medical costs, inpatient costs, and HCRU (all p <.05).

CONCLUSIONS

From 2020 through 2022, PLWH with CVD, hypertension, or T2DM experienced a greater HCRU and cost burden than those without these comorbidities. The results highlight the need for individualized HIV care and tailored screening and risk modification interventions for CVD, hypertension, and T2DM.