Medical Costs and Resource Utilization for Hemophilia Patients With and Without HIV or HCV Infection

BACKGROUND: Previous research has shown that hemophilia patients infected in the 1980s with human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) from the blood supply have increased morbidity and mortality. Although the possibility of contracting HIV or HCV through contaminated blood products has been virtually eliminated in the United States, approximately one third of hemophiliacs between the ages of 21 and 60 years are HIV infected. OBJECTIVES: To determine the health care resource utilization of adult hemophilia patients with and without HIV and HCV infection in a commercially insured population in the United States. METHODS: This was a retrospective claims analysis of the PharMetrics Patient-Centric database over an approximately 7-year period from January 1997 to April 2004. The database represents about 43 million members in commercial health plans. Male patients continuously enrolled for at least 6 months and greater than18 years of age were included in the study; female patients were excluded since they were likely to have von Willebrand disease. Hemophilia patients were identified if they had at least 1 claim with a primary diagnosis of hemophilia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 286.XX) and at least 1 claim for a hemophilia drug (identified by National Drug Code number and J codes: J7190-J7199, Q0187 or Q2022). Clotting factor inhibitor patients identified through the dispensation of an activated prothrombin complex concentrate or recombinant factor VIIa were excluded from the study. Virally infected patients were identified as those hemophilia patients with at least 1 claim with a HIV diagnosis (ICD-9-CM codes 042.xx, 079.53) or HCV infection (ICD-9-CM codes 070.41, 070.44, 070.51, 070.54). Four cohorts for analysis were established: hemophilia without HIV or HCV coinfection (H-only); hemophilia + HIV (H + HIV); hemophilia + HCV (H + HCV); and hemophilia + HIV + HCV (H + HIV + HCV). The index date was defined as the first day of enrollment. Follow-up lasted until the end of the patient's enrollment or the end of the study period. The main outcomes of the study were (1) annualized net costs paid by health plans (after subtracting member cost-share) associated with all pharmacy and medical claims and (2) office visit distribution overall and by physician specialty during the study period. RESULTS: A total of 166 patients were identified for the study 73 with H-only, 12 with H + HIV, 44 with H + HCV, and 37 with H + HIV + HCV. The mean (median) annualized total cost of care in 2004 dollars was $90,942 ($63,613) for the H-only cohort versus $108,862 ($64,782, P=0.512) for the H + HIV cohort; $104,404 ($66,489, P=0.377) for the H+HCV cohort; and $144,462 ($111,542, P=0.005) for the H + HIV + HCV coinfected cohort. Clotting factor accounted for 78% - 86% of total health care costs for all 4 groups of patients. Compared with the H-only cohort ($2,136), the H + HIV, H + HCV, and H + HIV + HCV cohorts had significantly higher mean non-hemophilia prescription drug costs ($8,239 [P = 0.001]; $7,275 [P=0.034]; and $12,360 [P less than 0.001], respectively). The H + HIV + HCV cohort had significantly higher hospital inpatient costs than did the H-only cohort ($5,655 vs. $3,360, respectively, P=0.015). Mean annualized outpatient costs were higher in the H + HIV + HCV cohort ($12,897, P less than 0.001) and H + HCV cohort ($7,233, P=0.016) than in the H-only cohort ($7,216). Mean annualized total numbers of office visits were higher for the H + HCV (11.18, P = 0.003) and H + HIV + HCV (18.33, P less than 0.001) cohorts than for the H-only cohort (6.98). Compared with the H-only cohort, the H + HIV + HCV cohort had a greater mean annualized number of visits to infectious disease specialists (3.75 vs. 0.12, P less than 0.001) and to gastroenterology specialists (1.22 vs. 0.09, P less than 0.001). CONCLUSION: The presence of HIV and HCV coinfection in hemophiliacs is associated with 59% (95% confidence interval, 34.8%, 82.9%) greater annual health care costs compared with costs for hemophilia alone. Coinfection with HIV and HCV is associated with significantly greater component costs for clotting factor, prescription drugs, inpatient services, and outpatient services.