The epidemiology, treatment patterns, and costs of cytomegalovirus retinitis in the post-haart era among a national managed-care population.

To examine the epidemiology, treatment patterns, and costs of cytomegalovirus (CMV) retinitis treatment in the post-HAART (highly active antiretroviral therapy) era, a retrospective cohort study was performed using data from US managed-care plans from 1997-2002. Cases with CMV retinitis were defined by requiring diagnosis codes for HIV (or AIDS), CMV, and retinitis and claims for anti-CMV treatment. Costs of oral, intravenous, and intraocular treatment periods were examined. The incidence of enrolled HIV or AIDS cases increased from 7 per million members in 1997 to 150 per million members in 2001. The incidence of CMV retinitis decreased from 23 per 10,000 HIV or AIDS cases in 1997 to 8 per 10,000 HIV or AIDS cases in 2001. The average duration of a CMV episode was 192 days and the average cost was 19,576 US dollars. In a multiple linear regression model adjusting for age, gender, insurance type, geographic region, HAART use, and co-existing AIDS-defining illnesses, intraocular and oral treatment periods saved 7135 and US dollars and 6866 US dollars, respectively, per treatment period compared with intravenous treatment (P < 0.05). The incidence of CMV retinitis decreased in this managed-care population during the post-HAART era. Use of oral or intraocular treatment saves costs compared with intravenous treatment in a managed-care environment.

Medical resource use and costs of congestive heart failure after carvedilol use.

A retrospective cohort study based on claims and medical chart data was conducted to compare healthcare use and costs in congestive heart failure patients with and without carvedilol. Adult patients with a minimum of two claims with a valid congestive heart failure diagnosis from 1997 to 1999 were included. Patients receiving continuous carvedilol treatment for at least 4 months were considered study case patients. Case patients were matched based on age, gender, race, and concomitant medication. Healthcare use and costs were compared between the case and control groups. A total of 128 case and 147 control patients were identified. There were no significant differences in demographic characteristics, concomitant medication, or New York Heart Association classification between these two groups. Analysis of variance and chi-square analyses were conducted for continuous and categorical variables, respectively. Statistical adjustments were made using a multivariate model. Carvedilol had a significant economic reduction in the overall expenditures by approximately $14,530. Facility expenditures were approximately $9,000 lower for the carvedilol group than for the control group. Carvedilol-treated patients had less frequent hospital admissions and shorter lengths of stay compared with patients not receiving carvedilol. Congestive heart failure patients receiving carvedilol have significantly less healthcare use and costs than patients not receiving carvedilol.