by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

February 13, 2024

Featured Literature:

Erly S, Dombrowski JC, Khosropour C, Reuer JR, Boersema K, Sharma M.  Cost Analysis of Implementing a 12-Month Recertification Criterion for Ryan White HIV/AIDS Program’s AIDS Drug Assistance Program in Washington State.  Public Health Rep.  2024 Feb 8:333549241227118.  doi: 10.1177/00333549241227118.  PMID: 38327231. 

Washington state investigators modeled 5-year costs and virologic suppression outcomes of changing from a 6- to a 12-month ADAP recertification schedule, to help inform policy decisions on the feasibility and effect of implementing new recertification timings.  Key outcomes included: (a) projected cost of the Washington State ADAP, (b) number of people virologically suppressed, and (c) number of people who received services while ineligible for ADAP.  The model was stratified by health insurance type (public, private, or none) and receipt of case management services; 2017-2019 enrollment data informed transition probabilities.  Data on the monthly cost of ADAP services by health insurance type and case management status were obtained from the state Department of Health administrative database.  Under a continued 6-month recertification criteria, the model estimated ADAP would enroll 4,727 clients/month at a per-client cost of $7,966 (at the end of the 5-year period, 6,834 clients would be virologically suppressed and total program cost was estimated at $37,663,000).  With a 12-month recertification, ADAP would enroll 5,331 clients/month at a per-client cost of $7,543 (at the end of the 5-year period, 7,079 clients would be virologically suppressed and total cost was estimated at $40,217,000).  Under the 12-month scenario, 245 more people would be virologically suppressed by the end of 2025.  The $423 reduction in cost/client corresponded to a ~5% lower administrative cost.

Author’s Commentary:

Studies such as these are vital to identifying administrative and policy opportunities which might lead to improved health outcomes and address long-standing structural inequities within a constrained funding environment.  Findings of this analysis, which are specific to the ADAP Program, mirror results from similar evaluations of Medicaid eligibility policies which support less frequent recertification processes.  Authors note their model did not take into account additional, indirect outcomes such as improvement in co-occurring health conditions and reductions in HIV transmission, therefore the benefits described above may be underestimating the broader impact of continuous coverage and program support.

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