Distribution of health care expenditures for HIV-infected patients
Distribution of health care expenditures for HIV-infected patients
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DOI：
10.1086/500453
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发表时间：
2006-04-01
影响因子：
11.8
通讯作者：
Saag, MS
中科院分区：
文献类型：
--
作者：
Chen, RY;Accortt, NA;Saag, MS
背景在美国，根据实际医疗保健使用情况确定的人类免疫缺陷病毒（HIV）感染者的医疗保健支出在高效抗逆转录病毒治疗时代尚未报道。在伯明翰亚拉巴马大学HIV诊所接受初级保健的患者被纳入研究。对2000年3月1日至2001年3月1日在伯明翰亚拉巴马大学医院系统内发生的所有遭遇（急诊室就诊除外）进行了分析。药品支出是根据2001年平均批发价格确定的。住院费用是根据2001年医疗保险诊断相关的团体报销率确定的。诊所支出是根据2001年医疗保险现行程序术语报销率确定的。在这635名患者中，患者每年的总支出用于CD 4（+）细胞计数！50个细胞/μ L（每名患者36，533美元）是CD 4+细胞计数>= 350个细胞/mL（每名患者13，885美元）患者年度总支出的2.6倍，主要是因为非抗逆转录病毒药物和住院费用增加。高活性抗逆转录病毒治疗的支出相对稳定，在CD 4（+）细胞计数各阶层中，每年每名患者的支出约为10，500美元。门诊费用为每名患者每年1558美元;然而，这些费用中的诊所和医生部分仅为每名患者每年359美元，占年度费用的2%。HIV感染者的医疗保健支出在晚期疾病患者中大幅增加，主要由药物费用驱动（占年度费用的71% - 84%）。医生报销，即使100%的计费和收款，也不足以支持大多数提供艾滋病毒护理的诊所的活动。这些发现对继续支持美国的艾滋病毒治疗计划具有重要意义。
Background. Health care expenditures for persons infected with human immunodeficiency virus ( HIV) in the United State determined on the basis of actual health care use have not been reported in the era of highly active antiretroviral therapy.Methods. Patients receiving primary care at the University of Alabama at Birmingham HIV clinic were included in the study. All encounters ( except emergency room visits) that occurred within the University of Alabama at Birmingham Hospital System from 1 March 2000 to 1 March 2001 were analyzed. Medication expenditures were determined on the basis of 2001 average wholesale price. Hospitalization expenditures were determined on the basis of 2001 Medicare diagnostic related group reimbursement rates. Clinic expenditures were determined on the basis of 2001 Medicare current procedural terminology reimbursement rates.Results. Among the 635 patients, total annual expenditures for patients with CD4(+) cell counts ! 50 cells/mu L ($36,533 per patient) were 2.6-times greater than total annual expenditures for patients with CD4+ cell counts >= 350 cells/mL ($13,885 per patient), primarily because of increased expenditures for nonantiretroviral medication and hospitalization. Expenditures for highly active antiretroviral therapy were relatively constant at similar to$10,500 per patient per year across CD4(+) cell count strata. Outpatient expenditures were $1558 per patient per year; however, the clinic and physician component of these expenditures represented only $359 per patient per year, or 2% of annual expenses. Health care expenditures for patients with HIV infection increased substantially for those with more-advanced disease and were driven predominantly by medication costs ( which accounted for 71% - 84% of annual expenses).Conclusions. Physician reimbursements, even with 100% billing and collections, are inadequate to support the activities of most clinics providing HIV care. These findings have important implications for the continued support of HIV treatment programs in the United States.