The ECONOMICS of HIV/AIDS

1. The ECONOMICS of HIV/AIDS SCHIV/AIDS Care Crisis Task Force Forums Prepared by Lynn Bailey , Health Care Economist Mary Tyrell, PhD, Health Care Informatisist

2. HIV/AIDS The Basics • AIDS is acquired immune deficiency syndrome • AIDS makes patients’ immune system malfunction • AIDS patients are susceptible to a broad variety of infections and tumors • HIV is human immunodeficiency virus • HIV causes AIDS • HIV/AIDS is the common denotation • HIV/AIDS is now a chronic health condition

3. How Many South Carolinians? • According to SC DHEC ≈ 10,000 to 16,000 people in SC are living with AIDS/HIV • SC ranks 9th in the nation in annual rates of HIV/AIDS • On average in SC, 800 cases are diagnosed annually; leaving ≈ 160 cases undiagnosed • Nationally on average only 51% of HIV/AIDS patients have regular access to care • With effective antiretroviral therapy patients can significantly reduce the spread of HIV

4. SC AIDS/HIV Belt Source: SC STD/HIV/AIDS Data Surveillance Report Dec. 2010

5. SOUTH CAROLINA • All 46 counties • 2009 had 782 new cases 2010 had 800 new • Since the 1980s cumulative cases = 24,964 • Over half have died

6. What does HIV/AIDS Costs? • Costs of care • Inpatient • Emergency Department • Outpatient in Clinic/Physician Office • This is South Carolina data from Office of Research and Statistics and from a large self insured group • Opportunity Cost is lost earning potential

7. What are HIV/AIDS Hospital Costs? • In 2010 Inpatient Hospital Charges for HIV/AIDS average $41,462/discharge or $6,097 a day with a length of stay of 7 days • ≈ 2 times the typical SC hospital inpatient charge • Newborn (only a few) = $65,981 per discharge • ≈ 7 times “typical” newborn charge • Pediatric (only a few) = $16,292 • ≈ 5 times “typical” pediatric patient charge • Young Adult (18-35) = $11,948 • ≈ 2.5 times typical young adult charge Source: ORS Inpatient Hospital Data Set

8. What are HIV/AIDS Outpatient Costs? • Drugs (based on claims paid data) $14,445 annually for 2010 or ≈ $1,200 a month • Physician Office Visits = $10,445 annually • Hospital Outpatient (lab, imaging, o/p surgery etc.) = $ 3,015 • Outpatient charges run ≈ $2,300 month/patient Source: Large self insured group claims data base

9. What are HIV/AIDS ED Costs? • Data excluded trauma charges • In SC in 2010, a total 1.4 M ED visits • 5,804 were for HIV/AIDS [less than 1% visits] • Average SC ED charge is $2,194 • Average SC HIV/AIDS charge is $ 2,721 • Only 25% more than typical ED charge probably from extra lab charges Source: ORS Inpatient Hospital Data Set

10. Opportunity Costs • Average private employer wage (2 Qtr 2011 for SC) = $36,660 or $705/week • Average State/local gov’t = $40,508 or $779/week • Average Education & Health wage = $43,342 or $834/week • Keeping an HIV/AIDS patient employed is worth on average $40,000 in annual wages

11. The TAKE AWAY • To care for an HIV/AIDS patient in an outpatient setting including medication is an estimate of ≈ $28,000 annually in SC • If an HIV/AIDS patient is hospitalized the charges triple • Preventing HIV/AIDS can save us all money • Preventing just half or 400 SC cases of HIV/AIDS annually could save us ≈ $100M in health care (public and private) annually