Costs of Care for People Living with Combined HIV/AIDS, Chronic Mental Illness and Substance Abuse D...
This presentation is the property of its rightful owner.
Sponsored Links
1 / 11

Christopher J. Conover, Duke University Susan L. Ettner, UCLA PowerPoint PPT Presentation


  • 74 Views
  • Uploaded on
  • Presentation posted in: General

Costs of Care for People Living with Combined HIV/AIDS, Chronic Mental Illness and Substance Abuse Disorders. Christopher J. Conover, Duke University Susan L. Ettner, UCLA Marcia Weaver, University of Washington Alfonso Ang, UCLA Peter Arno, Montefiore Medical Center

Download Presentation

Christopher J. Conover, Duke University Susan L. Ettner, UCLA

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Christopher j conover duke university susan l ettner ucla

Costs of Care for People Living with Combined HIV/AIDS, Chronic Mental Illness and Substance Abuse Disorders

Christopher J. Conover, Duke University

Susan L. Ettner, UCLA

Marcia Weaver, University of Washington

Alfonso Ang, UCLA

Peter Arno, Montefiore Medical Center

Patrick M. Flynn, Texas Christian University

For the Cost Subcommittee of the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study


Research questions

Research Questions

  • What are the average monthly inpatient, outpatient and medication costs of triply diagnosed patients and how do they vary by patient characteristics?

  • Which patient characteristics are associated with total costs and access to care?

    • Demographic (age, sex, race/ethnicity)

    • Socioeconomic (education, income, insurance)

    • Household structure/social support (marital status, adults in HH, children in HH, stable residence)

    • Clinical characteristics (exposure, PCS and MCS scores, viral load)


Methods

Methods

  • Data on patient characteristics and service use during past 3 months came from baseline patient interviews

  • Costs calculated as (units of each service) * (unit cost of that service), added up across services

  • Unit costs primarily derived from Medicare (Red Book used for medications)

  • Multiple linear and logistic regressions used for log of total costs and access measures respectively

  • Predictive margins and relative risks calculated along with bootstrapped 95% confidence intervals


How do total costs vary

How Do Total Costs Vary?

  • Education >16 years (+ $614 compared to <12 years)

  • Same-sex exposure (+ $104 relative to IV drug user)

  • Insurance

    • Medicaid (+ $1,492 relative to uninsured)

    • Medicare (+ $2,229 relative to uninsured)

  • Physical health

    • Poor physical health (+ $2,236 for bottom quartile compared to top quartile)

    • High viral load (+$1,315 for top quartile compared to bottom quartile)

  • Blacks (- $914 compared to whites and others)

  • Stable residence (- $889 compared to not in stable residence)


How does access vary

How Does Access Vary?

  • 5% of triply diagnosed had no outpatient medical visits during the 3 months pre-baseline

    • Medicare had lower risk than uninsured (RR=0.35)

    • Higher viral load had higher risk compared to 0-999 (RR=3.33 for 10K-100K, RR=4.03 for >100K)

  • 18% had > 1 ER visit without companion hospitalization

    • Same-sex exposure had higher risk than IV drug users (RR=1.81)

    • Lowest quartile for mental health had higher risk than highest quartile (RR=1.44)

  • 24% had > 1 hospitalization

    • Women had higher chance than men (RR=1.32)

    • Moderate income =>higher chance than low income (RR=1.38 for income 50-75% of poverty vs. < 50% )


Cost conclusions

Cost Conclusions

  • Triply diagnosed are highly expensive to treat

    • Our study patients cost $3,880 monthly, compared with $1,957 (in 2002 $) for HCSUS patients

    • Triply diagnosed may account for 20-55% of all HIV/AIDS medical spending

  • Share of cost due to medications and outpatient care is large => focus on inpatient alone is inappropriate

    • 33% drugs and 31% outpatient

  • Potential for cost savings through improved treatment adherence is high


Access conclusions

Access Conclusions

  • Realized access is good for many triply diagnosed patients

  • Care remains suboptimal

  • Deficiencies in care unevenly distributed

  • Apparent access problems appear to concentrate on already disadvantaged populations

  • Challenge: how to improve access and adherence cost-effectively


Christopher j conover duke university susan l ettner ucla

Gender

Age

Race/Ethnicity


Christopher j conover duke university susan l ettner ucla

Education

Income as % of Poverty

Health Insurance


Christopher j conover duke university susan l ettner ucla

Viral Load

Exposure


  • Login