Healthcare Utilization and Costs in People Living with HIV and Neuropsychiatric Disorders in the United States

INTRODUCTION: People living with HIV (PLWH) face an increased prevalence and risk of neuropsychiatric disorders than individuals without HIV. This study compared incremental all-cause healthcare resource utilization (HCRU) and costs among US antiretroviral therapy (ART)-treated PLWH with versus without neuropsychiatric disorders. METHODS: Data Mart Database (Jan 2020-Dec 2022). Adults (≥ 18 years) with HIV and ≥ 1 pharmacy claim for an anchor ART agent [integrase strand transfer inhibitor (INSTI), non-nucleoside reverse transcriptase inhibitor (NNRTI), or protease inhibitor (PI)] in 2021 were included (index date: earliest anchor ART claim). PLWH were followed up to 12 months or end of continuous enrollment. Neuropsychiatric disorders were identified during the baseline period (12 months pre-index) using ICD-10 diagnosis codes, and cohorts were defined based on their presence (yes/no). Differences between neuropsychiatric groups in per-patient-per-month (PPPM) HCRU and costs (converted to 2023 USD) were estimated using multivariable generalized linear models (negative binomial/Poisson for HCRU; gamma for costs), adjusting for baseline characteristics. RESULTS: Among 22,402 PLWH, 9506 (42.4%) had neuropsychiatric disorders. PLWH with versus without neuropsychiatric disorders were older (mean age 56 vs. 54 years), more often female (21.0% vs. 17.5%), white (51.0% vs. 44.0%), had higher comorbidity (mean Quan-Charlson 1.82 vs. 0.92), and baseline total costs ($4579 vs. $3416); all P < 0.001. Unadjusted all-cause PPPM HCRU and costs were significantly higher among PLWH with neuropsychiatric disorders than among those without; all P < 0.001. PLWH with neuropsychiatric disorders generally had higher adjusted all-cause PPPM HCRU (including 28% more office visits) and higher total costs; outpatient emergency department and outpatient other visit and costs were not significantly different. CONCLUSIONS: PLWH with neuropsychiatric disorders have higher all-cause HCRU and costs than those without these conditions. Further research on the role of HIV and ART in the development of neuropsychiatric disorders may support more individualized care and help reduce excess HCRU and costs.