OBJECTIVES:

Several studies have suggested people living with HIV (PLWH) are at increased risk of certain co-morbidities, including renal disease and osteoporosis. There are currently limited UK data on the additional cost associated with co-morbidities in this group. We aimed to use a national database, the Hospital Episode Statistics (HES), containing information including all admissions to characterise and assess economic implications of inpatient episodes.

METHODS:

We analysed 5 years of HES data (April 2011-March 2016) to extract episodes coded with a HIV diagnosis and a concurrent diagnosis of co-morbidities of interest – renal disease and osteoporosis; non-HIV episodes for each co-morbidity were also extracted as a control group. Relevant ICD10 codes for each co‑morbidity were obtained from the Charlson co-morbidity index. Cost per episode (tariff derived from both diagnosis-based Healthcare Resource Group and matched NHS reference costs) was evaluated between the groups.

RESULTS:

A total of 83,388 HIV coded episodes were identified, with 5,103 renal disease and 1,608 osteoporosis coded episodes. The average age for episodes coded as renal disease (48 vs. 68; p<0.01) and osteoporosis (53 vs. 76; p<0.01) were two decades lower for PLWH than controls. Average cost per episode was higher in PLWH compared to the non-HIV control group: renal; £1,899 vs. £937 (p<0.01) and osteoporosis; £2,799 vs. £2,132 (p<0.01). We estimate the additional HIV-associated economic burden of these co-morbidities to be £5.98M over 5 years, assuming the difference in cost is applied to the total number of HIV episodes for these co‑morbidities.

CONCLUSIONS:

HIV-associated renal and bone co-morbidities present 20 years earlier and add significant additional economic burden. Early identification and proactive management of patients at increased risk could reduce this burden. This large dataset is valuable in highlighting increased inpatient episode cost. With an ageing population of PLWH, financial impact will increase further.