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Antiretroviral Therapy and Health Care Utilization: A Study of Privately Insured Men and Women with HIV Disease


  • Fred J. Hellinger,

  • William E. Encinosa

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    • Address correspondence to Fred J. Hellinger, Ph.D., Agency for Healthcare Research and Quality (AHRQ), CDOM, Room 5319, 540 Gaither Rd., Rockville, MD 20850. William E. Encinosa, Ph.D., is also with AHRQ. The opinions expressed are those of the authors and not those of AHRQ.


Objective. To compare the use of antiretroviral therapy and other health care resources by women and men with HIV disease who are privately insured.

Data Sources. Data were obtained from the MarketScan Commercial Claims and Encounter Database produced by the Medstat Group, Inc., of Ann Arbor, Michigan. This database includes eligibility files as well as claims data for inpatient care, outpatient care, physician services, and prescription drugs for enrollees in employer-sponsored benefit plans for 24 large employers around the nation.

Study Design. Examine utilization by 2,026 privately insured persons (1,494 men and 532 women) with HIV disease in calendar year 2000 under the age of 65.

Principal Findings. Using a simple comparison, we found that 71 percent of men (68.7 to 73.3 percent is 95 percent confidence interval) and 39 percent of women (35.1 to 43.5 percent is 95 percent confidence interval) with HIV disease received antiretroviral therapy. We also found that the average annual drug cost was $9,037 for a man ($8,372 to $9,702 is 95 percent confidence interval) and $3,893 for a woman ($3,476 to $4,490 is 95 percent confidence interval). Furthermore, we found that the out-of-pocket expenses comprised 10 percent of total expenses for men ($1,617 out of $16,405) and 4 percent for women ($405 out of $10,397).


There are major differences in the utilization and cost of health care between privately insured men and women with HIV disease.