Trends in Healthcare Costs among People Living with HIV in Ontario, Canada, 2003-2018: Results from a Population-Based Retrospective Cohort Study

ObjectiveTo quantify trends in annual mean healthcare costs per person living with HIV from 2003 to 2018 from a publicly funded healthcare system perspective. DesignWe conducted a retrospective population-based study using administrative health data in Ontario, Canada, including 25,842 people living with HIV diagnosed and entering care between 1992 and 2018. A nested cohort from the Ontario HIV Treatment Network Cohort Study (n=3,516) provided additional HIV-related characteristics. MethodsAnnual mean healthcare costs per person were estimated using a validated costing algorithm and inflated to 2025 Canadian dollars. Trends were examined overall and stratified by sociodemographic factors (age, sex, rurality, neighbourhood income, immigration status) and year of entry into HIV care. Within the nested cohort, trends were stratified by nadir CD4 count and any antiretroviral therapy use since diagnosis. ResultsAnnual mean cost per person increased from $11,963 in 2003 to $16,721 in 2018. Medication costs remained the largest cost component throughout (47.4-61.7%) and closely mirrored overall trends. Higher annual mean costs were consistently observed among individuals diagnosed at older ages, lower-income neighbourhood residents, long-term Ontario residents (Canadian-born or immigrated before 1985), and individuals with nadir CD4<200cells/{micro}L. ConclusionMedication expenditures continue to drive healthcare costs for people living with HIV. Cost containing strategies, including expanded generic substitution and strengthened price negotiation, may reduce costs without compromising outcomes. Persistent cost disparities highlight the need to address delayed treatment initiation and broader social determinants shaping HIV treatment access and sustained engagement in care.