Cost of HIV and determinants of health care costs in HIV-positive patients in Germany – Results of the DAGNÄ K3A Study

The rising prevalence of human immunodeficiency virus (HIV)-infection in Germany leads to an increasing health economic burden. However there is a lack of nation-wide data on the current medical and societal costs of HIV and AIDS. Objectives: The aims of this study were to estimate the medical expenditures for HIV-care in Germany and to identify variables associated with resource use. Methods: We performed an 18-months prospective multi-centre study in an HIV-specialized ambulatory care setting from 2006–2009. All health care costs were estimated following a bottom-up approach from two perspectives: 1) those incurred to society in general and 2) those incurred to statutory health insurance. Clinical and health economic data were obtained using questionnaires, patient interviews and physician clinical documentation. Several empirical models for identifying the relationship between health care costs and independent variables were developed. Results: 518 patients from 17 centres were included in this health economic analysis. Average annual health care costs were €23,298 per patient from the societal perspective and €19,103 from the statutory health insurance perspective. Most expenses were derived from drug expenditures (80% of the total and 89% of direct costs), while hospital costs represented 7% of total expenditures. A statistically significant association was found between health care costs and clinical variables with a higher CD4 count and female gender generating lower costs, while increased antiretroviral experience and injection drug use (IDU) as a mode of transmission led to higher expenditures (p<0.05). Health care expenditures for HIV-infection are mainly driven by drug costs. We identified several clinical variables influencing the cost of HIV-treatment. This information could assist policymakers in their decision-making processes when allocating limited health care resources to HIV care.