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Study uncovers major differences in the use and cost of health care for privately insured men and women with HIV

Women with HIV disease are much less likely than men with HIV to receive potentially life-prolonging drugs even though they have private health insurance that would help pay for the drugs, according to a recent study from the Agency for Healthcare Research and Quality. Fred J. Hellinger, Ph.D., and William E. Encinosa, Ph.D., of AHRQ's Center for Delivery, Organization, and Markets, found that only 39 percent of women with HIV disease enrolled in the health insurance plans of 24 large employers across the country were provided antiretroviral drugs for HIV disease in 2000, compared with 71 percent of men with HIV enrolled in the same plans. Access to these drug therapies is linked to increased survival and a higher quality of life for individuals with HIV disease.

The researchers further found that among adults treated with antiretroviral therapy, women (31 percent) were only half as likely as men (63 percent) to be prescribed the newer, more effective, and more costly protease inhibitor and/or non-nucleoside reverse transcriptase inhibitor drugs. Therapy involving these two types of drugs, which were approved for use after 1995, is known as highly active antiretroviral therapy or HAART.

This disparity in prescribing for men and women was reflected in prescription drug expenditures. The average annual drug expenditure for men, $9,037, was more than twice the $3,893 spent for women's medications. Women, on average, had total health care expenditures of $10,397 in 2000, while total health care expenditures for men averaged $16,405 that year. Almost all of this difference resulted from lower payments for drugs for women with HIV disease.

The findings from this study are surprising, since the study participants were privately insured and should have had equal access to drug therapies, note Drs. Hellinger and Encinosa. They point out that the reasons behind the disparity in access to costly new drug therapies are not clear and warrant further study, particularly since the incidence of HIV disease is now increasing more rapidly among women than men. In addition, we need to know more about the extent of such disparities among uninsured and publicly insured men and women with HIV disease.

For details, see "Antiretroviral therapy and health care utilization: A study of privately insured men and women with HIV disease," by Drs. Hellinger and Encinosa, in the August 2004 Health Services Research 39(4), pp. 949-967.

Reprints (AHRQ Publication No. 04-R054) are available from the AHRQ Publications Clearinghouse.

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