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Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection.

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Title: Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection.
Authors: Zhang, Shun (AUTHOR), Rust, George (AUTHOR), Cardarelli, Kathryn (AUTHOR), Felizzola, Jesus (AUTHOR), Fransua, Mesfin (AUTHOR), Stringer, Harold G. (AUTHOR)
Source: AIDS Care. Jul2015, Vol. 27 Issue 7, p829-835. 7p. 4 Charts, 1 Graph.
Subjects: Evaluation of medical care, Analysis of variance, Antiviral agents, Confidence intervals, Cost effectiveness, Databases, Drugs, Hepatitis C, HIV-positive persons, Hospital admission & discharge, Hospital emergency services, Research methodology, Medicaid, Mortality, Patient compliance, Patients, Quality of life, Research funding, Health insurance reimbursement, Socioeconomic factors, Relative medical risk, Proportional hazards models, Retrospective studies, Descriptive statistics, Kaplan-Meier estimator, Mixed infections
Geographic Terms: United States
Abstract: We examined the impact of antiretroviral treatment adherence among hepatitis C (HCV) coinfected human immunodeficiency virus (HIV) patients on survival and clinical outcomes. We analyzed Medicaid claims data from 14 southern states from 2005 to 2007, comparing survival and clinical outcomes and cost of treatment for HIV and HCV coinfected patients (N= 4115) at different levels of adherence to antiretroviral therapy (ART). More than one in five patients (20.5%) showed less than 50% adherence to antiretroviral treatment, but there were no racial/ethnic or gender disparities. Significant survival benefit was demonstrated at each incremental level of adherence to ART (one-year mortality ranging from 3.5% in the highest adherence group to 26.0% in the lowest). Low-adherence patients also had higher rates of hospitalization and emergency department visits. Relative to patients with high (>95%) ART adherence, those with less than 25% treatment adherence had fourfold greater risk of death (adjusted odds ratio 4.22 [95% CI: 3.03, 5.87]). Nondrug Medicaid expenditures were lower for high-adherence patients, but cost of medications drove total Medicaid expenditures higher for high-adherence patients. Cost per quality-adjusted life year (QALY) saved (relative to the <25% low-adherence group) ranged from $21,874 for increasing adherence to 25–50% to $37,229 for increasing adherence to 75–95%. Adherence to ART for patients with HIV and HCV coinfection is associated with lower adverse clinical outcomes at a Medicaid cost per QALY commensurate with other well-accepted treatment and prevention strategies. Further research is needed to identify interventions which can best achieve optimal ART adherence at a population scale. [ABSTRACT FROM AUTHOR]
Copyright of AIDS Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22AIDS+Care%22&quot;&gt;AIDS Care&lt;/searchLink&gt;. Jul2015, Vol. 27 Issue 7, p829-835. 7p. 4 Charts, 1 Graph.
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  Data: We examined the impact of antiretroviral treatment adherence among hepatitis C (HCV) coinfected human immunodeficiency virus (HIV) patients on survival and clinical outcomes. We analyzed Medicaid claims data from 14 southern states from 2005 to 2007, comparing survival and clinical outcomes and cost of treatment for HIV and HCV coinfected patients (N= 4115) at different levels of adherence to antiretroviral therapy (ART). More than one in five patients (20.5%) showed less than 50% adherence to antiretroviral treatment, but there were no racial/ethnic or gender disparities. Significant survival benefit was demonstrated at each incremental level of adherence to ART (one-year mortality ranging from 3.5% in the highest adherence group to 26.0% in the lowest). Low-adherence patients also had higher rates of hospitalization and emergency department visits. Relative to patients with high (&gt;95%) ART adherence, those with less than 25% treatment adherence had fourfold greater risk of death (adjusted odds ratio 4.22 [95% CI: 3.03, 5.87]). Nondrug Medicaid expenditures were lower for high-adherence patients, but cost of medications drove total Medicaid expenditures higher for high-adherence patients. Cost per quality-adjusted life year (QALY) saved (relative to the &lt;25% low-adherence group) ranged from $21,874 for increasing adherence to 25–50% to $37,229 for increasing adherence to 75–95%. Adherence to ART for patients with HIV and HCV coinfection is associated with lower adverse clinical outcomes at a Medicaid cost per QALY commensurate with other well-accepted treatment and prevention strategies. Further research is needed to identify interventions which can best achieve optimal ART adherence at a population scale. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of AIDS Care is the property of Taylor &amp; Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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    Identifiers:
      – Type: doi
        Value: 10.1080/09540121.2015.1021745
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 7
        StartPage: 829
    Subjects:
      – SubjectFull: Evaluation of medical care
        Type: general
      – SubjectFull: Analysis of variance
        Type: general
      – SubjectFull: Antiviral agents
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Cost effectiveness
        Type: general
      – SubjectFull: Databases
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      – SubjectFull: Drugs
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      – SubjectFull: Hepatitis C
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      – SubjectFull: HIV-positive persons
        Type: general
      – SubjectFull: Hospital admission & discharge
        Type: general
      – SubjectFull: Hospital emergency services
        Type: general
      – SubjectFull: Research methodology
        Type: general
      – SubjectFull: Medicaid
        Type: general
      – SubjectFull: Mortality
        Type: general
      – SubjectFull: Patient compliance
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      – SubjectFull: Patients
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      – SubjectFull: Health insurance reimbursement
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      – SubjectFull: Relative medical risk
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      – SubjectFull: Kaplan-Meier estimator
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      – SubjectFull: Mixed infections
        Type: general
      – SubjectFull: United States
        Type: general
    Titles:
      – TitleFull: Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection.
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              Text: Jul2015
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