IMPACT OF THE COVID-19 PANDEMIC ON HEALTHCARE EXPENDITURE AND RESOURCE USE IN PEOPLE LIVING WITH HIV IN THE UNITED STATES: A DIFFERENCE-IN-DIFFERENCE ANALYSIS
Author(s)
Elena Santocanale, MSc1, Tyler Malloch, MSc2, Victor Genestier, MSc2, Hsin-Yun Yang, PhD2;
1Amaris Consulting, Barcelona, Spain, 2Amaris Consulting, Toronto, ON, Canada
1Amaris Consulting, Barcelona, Spain, 2Amaris Consulting, Toronto, ON, Canada
OBJECTIVES: COVID-19 can negatively affect people living with HIV (PLWH), including through disruptions in access to antiretroviral drugs and care. To date, there are few analyses describing the causal impacts of the COVID-19 pandemic on health care expenditure and resource use for PLWH in the United States. The objective of this study was to determine the impact of the COVID-19 pandemic on healthcare expenditure in PLWH in the United States.
METHODS: This analysis utilized Medical Expenditure Panel Survey (MEPS) Panel 24 (2019-2022) data in conjunction with corresponding MEPS full-year consolidated, Medical Conditions and Prescribed Medications files to evaluate changes in healthcare costs for people living with HIV (PLWH). A transition-balanced Difference-in-Differences (DiD) and Triple-Difference (DDD) framework was applied using individual and year fixed-effects. All expenditures were inflation-adjusted to constant 2022 USD using the Consumer Price Index for Medical Care.
RESULTS: Post-pandemic, PLWH experienced a significant $7,861.31 increase in annual total healthcare expenditures (p < 0.05). These increases were primarily absorbed by private payers, with private insurance payments rising by $6,654.00 for total medical care (p < 0.01) and $6,382.86 for prescriptions (p < 0.01). Total out-of-pocket costs increased by $1,039.71 (p < 0.01). PLWH in the Midwest experienced the most acute shocks, with additional increases of $21,801.80 in total costs and $20,140.70 in pharmacy spending relative to the Northeast (p < 0.001). Asian PLWH similarly saw disproportionate increases in total spending ($14,014.70) and private prescription coverage ($10,333.10) compared to White counterparts (p < 0.001).
CONCLUSIONS: The pandemic caused financial and HCRU shock for PLWH, and shifted the burden primarily onto private insurers and patients. Severe regional and racial disparities highlight the need for targeted pharmaceutical cost-containment and equity-focused policy interventions during public health emergencies.
METHODS: This analysis utilized Medical Expenditure Panel Survey (MEPS) Panel 24 (2019-2022) data in conjunction with corresponding MEPS full-year consolidated, Medical Conditions and Prescribed Medications files to evaluate changes in healthcare costs for people living with HIV (PLWH). A transition-balanced Difference-in-Differences (DiD) and Triple-Difference (DDD) framework was applied using individual and year fixed-effects. All expenditures were inflation-adjusted to constant 2022 USD using the Consumer Price Index for Medical Care.
RESULTS: Post-pandemic, PLWH experienced a significant $7,861.31 increase in annual total healthcare expenditures (p < 0.05). These increases were primarily absorbed by private payers, with private insurance payments rising by $6,654.00 for total medical care (p < 0.01) and $6,382.86 for prescriptions (p < 0.01). Total out-of-pocket costs increased by $1,039.71 (p < 0.01). PLWH in the Midwest experienced the most acute shocks, with additional increases of $21,801.80 in total costs and $20,140.70 in pharmacy spending relative to the Northeast (p < 0.001). Asian PLWH similarly saw disproportionate increases in total spending ($14,014.70) and private prescription coverage ($10,333.10) compared to White counterparts (p < 0.001).
CONCLUSIONS: The pandemic caused financial and HCRU shock for PLWH, and shifted the burden primarily onto private insurers and patients. Severe regional and racial disparities highlight the need for targeted pharmaceutical cost-containment and equity-focused policy interventions during public health emergencies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE19
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Infectious Disease (non-vaccine)