HAART is associated with a growing prevalence of HIV-associated neuropsychiatric disorders (NPD) despite improved overall survival.Objective:
To investigate the added direct costs of medical care for patients with and without NPD.Methods:
Nine dimensions of patient-specific costs [as costs per patient per month (CPM)] were followed prospectively between 1997 and 2003 in a community-based HIV/AIDS clinic for HIV-1-seropositive patients with a diagnosis of NPD (n = 188) and without (n = 153). Patients with NPD were stratified into subgroups of cognitive impairment (CI), peripheral neuropathies (PN), or other neuropsychiatric disorders (OND).Results:
Compared with the non-NPD group ($916), patients in the NPD group showed an increased mean CPM during the 12-month intervals immediately preceding and subsequently following NPD diagnosis [$1371 (P < 0.001) and $1463 (P < 0.001), respectively], but not at 18 months prior to diagnosis ($1061; P > 0.05). Intragroup comparisons between 12 month post-diagnosis and 18 month pre-diagnosis showed a mean CPM increased of 67% ($1613; P < 0.001) with CI, 31% ($1490; P < 0.01) with PN, and 33% ($1362; P < 0.01) with OND. Increased numbers of clinic and physician visits, non-antiretroviral drugs and homecare accounted for the higher mean CPM (P < 0.05) both pre-and post-diagnosis within the NPD group.Conclusions:
Neuropsychiatric disorders in patients with HIV/AIDS increase medical costs both before and after diagnosis, primarily owing to the management of the neuropsychiatric illness. Cost analyses offer useful measures of evolving patient needs, and provide a basis for allocation of healthcare resources.