Hill AK (VA Palo Alto HCS)
Richardson SS (VA Palo Alto HCS)
Yu W (VA Palo Alto HCS)
The advent of highly active antiretroviral therapy (HAART) has dramatically increased the life expectancy of patients with HIV. Patients may still eventually die from HIV-related diseases; however, many patients now live long enough to die from other, non-HIV-related, health conditions. The objective of this study was to explore the causes of death and associated utilization and costs during the final two years of life for patients with HIV.
We identified 1,933 veterans with HIV who died during the interval October 1, 1999 to September 30, 2001. We compared three methods of identifying cause of death: (1) last diagnosis, (2) intensity of resource use, and (3) death certificate. We also evaluated the medical treatments and costs associated with the identified causes of death.
The average age at death was 52; 99% male; 38% white, 51% black. Using the last diagnosis method of calculating cause of death, we found that 16% died of cancer, 14% of flu/pneumonia, 12% of heart disease, 7% of nephritis, 6% of COPD, 5% of liver disorders, and 4% of diabetes. The remaining 36% died of other causes. This distribution is consistent with that found using an intensity of resource use classification, but is somewhat inconsistent with the death certificate method. Overall average inpatient, outpatient, and pharmacy costs during the last two years of life were $42,128, $9,808, and $7,247 respectively. However, the costs varied substantially by cause of death, ranging from an average inpatient cost of $36,620 for patients who died of heart disease to $56,263 for patients who died of nephritis. We are currently evaluating the cost differences by cause of death using the other two methods.
Many patients with HIV died from comorbid conditions and their medical care and costs varied by their major cause of death. Further study is needed to understand the relationship between HIV and comorbid conditions when patients approach the end of life.
Patients with HIV who are treated with HAART have prolonged survival; however clinicians must increasingly consider the effect of non-HIV-related diseases on this population.