End-of-Life Costs Among Older Adults Living with HIV

Speaker(s)

Bazzazzadehgan S1, Prajapati P2, Goswami S3, Eriakha O2, Lin LY1, Bhattacharya K4
1Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Oxford, MS, USA, 2Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA, 3Complete HEOR Solution LLC, Chalfont, PA, USA, 4Department of Pharmacy Administration and Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University, MS, USA

Presentation Documents

OBJECTIVES: Given the advancement in antiretroviral therapy, patients with human immunodeficiency virus (HIV) are living longer. However, little is known about end-of-life (EOL) costs among older adults living with HIV. This study aimed to examine the EOL costs among older adults living with HIV enrolled in Medicare.

METHODS: In this observational study, a cohort of Medicare beneficiaries with HIV diagnosis who died between 2012-2020 was identified from 5% national Medicare claims data. Beneficiaries included in the analysis were required to be at least 66 years old at the time of death, and have continuous enrollment in Medicare Parts A, B, and D for the 9-month period prior to death. Beneficiaries having any enrollment in Medicare Advantage plans in the 9-month period prior to death were excluded from the analysis. All-cause costs in the EOL period (3 months prior to death) were estimated. The cost components assessed included inpatient, outpatient, prescription drugs and other (comprising of home health and hospice). All cost components were adjusted to 2020 US dollars and assessed from Medicare’s perspective.

RESULTS: Of the 724 eligible beneficiaries, 71.96% were male, with mean age of 73.89 years (SD=7.02). A majority of them were residing in southern states (47.79%) and had any home health or hospice use (53.73%) during EOL period. Median total cost during EOL period was $38,360.54 [interquartile range (IQR): 16,542.30-68,289.58], with inpatient costs (median: $21,003.42, IQR: 050,014.54) being the major cost driver, followed by outpatient cost (median: $6,388.84, IQR: 2,408.51-11,931.78), and prescription drug cost (median: $3,230.15, IQR: 474.85-8,500.74).

CONCLUSIONS: In this cohort of older Medicare beneficiaries with HIV who died between 2012-2020, EOL costs pose a significant burden to Medicare. Further studies are required to identify predictors of EOL costs in this population and assess quality of care in the EOL period.

Code

EE94

Topic

Economic Evaluation, Study Approaches

Disease

Drugs, Infectious Disease (non-vaccine)