Treatment patterns, health care resource utilization, and costs of heavily treatment-experienced people with HIV in the United States

Abstract

Background: Although advancements in antiretroviral therapy (ART) have significantly improved outcomes for people with HIV (PWH), there remains a subset of PWH who are heavily treatment experienced (HTE) and at increased risk for poor outcomes, including AIDS-related complications and mortality. Objective: To describe the clinical characteristics, treatment patterns, health care utilization, and costs associated with HTE among PWH. Methods: Treatment-experienced PWH who had at least 2 ART lines of therapy (LOTs) between January 1, 2015, and December 31, 2022, were identified from the Veradigm Network electronic health record (EHR)-linked claims database. HTE PWH met at least 1 of 4 HTE-defining criteria based on ART indication and exposure, evidence of viremia, and/or ART resistance (index date = earliest criterion met). Patients were eligible for study inclusion if they were aged 18 years or older, had a prior HIV diagnosis, and had continuous claims enrollment and EHR activity for at least 6 months before and after the index date. A matched comparator group of treatment-experienced non-HTE PWH was also identified. Treatment patterns were measured for HTE PWH in a variable follow-up period lasting until the end of continuous enrollment or December 31, 2022. HIV-related clinical measures in the 6-month follow-up, and health care resource utilization and costs in the variable-length follow-up, were measured for both HTE PWH and non-HTE PWH. Results: Among the 19,221 HTE PWH identified in the Veradigm dataset, 2,507 met all remaining study criteria. On average, HTE PWH were aged 50.6 years and predominantly male (63.3%), Black (43.6%), and insured through Medicaid (56.7%). Over a mean 3 years of follow-up, more than 50% of HTE PWH had ART on hand for at least 75% of the follow-up period (median percentage of days = 75.4%); however, treatment modifications were common, as 58.1% had at least 3 LOTs during follow-up. Although the majority of HTE PWH avoided gaps in ART, 26.5% to 32.5% of people in each LOT experienced a gap in ART of at least 45 days. Mean (SD) annualized all-cause and HIV-related health care costs for HTE PWH vs non-HTE PWH were $69,529 ($156,077) vs $51,726 ($89,179) (P < 0.001) and $40,082 ($91,703) vs $30,717 ($66,926) (P < 0.001), respectively. Pharmacy costs and outpatient costs were the largest factors contributing to increased costs for HTE PWH. Conclusions: HTE PWH experienced frequent changes to their ART regimens, and they had higher disease burden, health care utilization, and health care costs compared with PWH who do not meet the criteria of HTE, suggesting an unmet need in this population.