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Medications comprise the third largest health care expenditure for children with HIV

In 1992, annual medication costs averaged $12,315 for a child with AIDs and $4,504 for an HIV-positive child; most of these costs were paid by Medicaid. In fact, medications are the third largest health care expenditure for children infected with HIV, according to David C. Hsia, M.D., M.P.H., J.D., of the Agency for Health Care Policy and Research. The other two-thirds of expenses are for hospital stays and outpatient services.

Dr. Hsia analyzed a representative sample of 100 children with AIDS and 41 children with HIV who participated in the 1991-1992 AIDS Cost and Services Utilization Survey (ACSUS), which was sponsored by AHCPR. He found that in 1992, average annual prescription charges for children with AIDS were nearly three times as much as for children with HIV ($2,821 vs. $1,109 for outpatient medications and $9,494 vs. $3,395 for inpatient medications). Antiretrovirals accounted for 28 percent of charges, Pneumocystis carinii pneumonia (PCP) prophylaxis for 3 percent, and other antimicrobials for 32 percent of medication charges. Multiplying by the reported prevalence of HIV disease in U.S. children in 1992 would produce total U.S. pharmacy charges of $48.2 million, most of which (67 to 77 percent) is paid by Medicaid.

On the basis of CD4 counts and age, about 15 percent of HIV-positive children and 14 percent of children with AIDS had indications for antiretroviral drugs but did not receive them; and 17 percent and 18 percent, respectively, warranted prophylaxis for PCP but did not receive it. Consensus groups now recommend simultaneous prophylaxis of HIV-infected children with both nucleoside analogs and protease inhibitors, which will further increase prescription costs. While not burdensome to the U.S. health care system as a whole (prescription costs for these children were less than one-tenth of 1 percent of the $71 billion spent on medications in 1992), for selected payers such as Medicaid, these additional costs could compound the effects of medical inflation and HIV's increasing prevalence.

More details are in "Medications used for paediatric HIV infection in the USA, 1991-1992," by Dr. Hsia, in AIDS Care 10(6), pp. 761-770, 1998.

Reprints (AHCPR Publication No. 99-R031) are available from the AHCPR Publications Clearinghouse

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