In the study, medications were the single costliest component, comprising $71 to $84 of every $100 spent, regardless of stage of disease. In sharp contrast, expenditures for physicians' services and clinic fees accounted for less than $2 of every $100, or on average, $360 per patient per year. This is far less than the providers' actual costs, which average approximately $1,500 to 2,000 per patient per year. The study assumed all patients had Medicare health insurance and the clinics were reimbursed 100 percent. "However, the majority of people who are infected with HIV are either uninsured or underinsured" and unable to pay for their care, said Dr. Saag. "So in reality, the actual reimbursement to clinics is markedly less than $360 per patient per year, making the situation even more dire," he added.
As a consequence, said Dr. Saag, "We are approaching a potential crisis in the availability of physicians to provide care for patients? Many private-practice HIV clinics are closing. Most academic institutions within the United States, including ours, are absorbing the cost of care for HIV patients" ?a burden that can range into the millions of dollars, he said. These treatment providers' necessary reliance on federal assistance "underscores the tremendous need for reauthorization of the Ryan White CARE Act with increased resources allocated for reimbursement of medical care, which is now under discussion in Congress," Dr. Saag said.
Although institutions are developing ways to bring down HIV treatment costs, they won't be able to cover those costs themselves indefinitely, Dr. Saag warned. Notwithstanding the promising findings on HAART's cost-effectiveness, "Providing drugs alone is not enough," he said. "We must focus now on creating appropriate incentives for providers to care for HIV patients. The current pool of providers is struggling to make ends meet.
Source:Infectious Diseases Society of America