Incremental healthcare resource utilization and costs among people living with HIV with and without chronic kidney disease in the United States

Abstract

Objective: To assess incremental all-cause healthcare resource utilization (HCRU) and costs among people living with HIV (PLWH) with and without chronic kidney disease (CKD) in the United States. Methods: A retrospective administrative claims analysis was conducted using Optum’s de-identified Clinformatics® Data Mart Database (Jan 2020–Dec 2022). Adult PLWH with ≥1 pharmacy claims for anchor antiretroviral (ART) agent in 2021 (index date: earliest anchor ART claim) were followed for 12 months or to the end of continuous enrollment and stratified based on the baseline presence of CKD (yes/no). Differences between CKD groups in per-person-per-month (PPPM) HCRU and costs (converted to 2023 USD) were estimated using multivariable generalized linear models adjusted for baseline characteristics. Results: Of 22,402 PLWH identified, 3,753 (16.8%) had CKD. PLWH with versus without CKD were older (mean age 63.35 vs 53.02 years), a larger proportion were women (23.2% vs >18.0%) or Black (35.7% vs 29.0%), and they had higher mean Quan-Charlson Comorbidity Index scores (3.23 vs 0.92) and baseline total costs ($5,259 vs $3,644); all p<0.001. Compared to PLWH without CKD, PLWH with CKD had significantly higher unadjusted all-cause PPPM HCRU and costs (all p<0.001), and significantly greater all-cause adjusted PPPM HCRU, total costs, medical costs, and inpatient costs (all p<0.001), whereas adjusted pharmacy costs were significantly lower (p=0.025). Conclusions: PLWH with CKD generally experience greater HCRU and cost burden than those without CKD. These increases may be mitigated by recognizing modifiable CKD risk factors and tailoring HIV care, which may also improve overall health of PLWH.