Thehigh cost of medical care for patients who present late (CD4< 200 cells/μL) with HIV infection
Thehigh cost of medical care for patients who present late (CD4< 200 cells/μL) with HIV infection
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DOI：
10.1111/j.1468-1293.2004.00193.x
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发表时间：
2004-03-01
期刊：
影响因子：
3
通讯作者：
Gill, MJ
中科院分区：
文献类型：
--
作者：
Krentz, HB;Auld, MC;Gill, MJ
目的比较CD 4计数< 200个细胞/穆尔的HIV感染者在确诊后一年内的直接医疗费用（“晚期先发型患者”）和CD 4计数> 200个细胞/穆尔的患者（“早期介绍者”）。（即药物、实验室检查、门诊护理、住院护理和家庭护理），收集了1996年4月至2001年4月期间在加拿大南阿尔伯塔接受HIV治疗的所有患者的社会人口学数据和临床数据。平均成本为成本在2001年加拿大dollar.Results百分之三十九的241例CD 4计数< 200个细胞/穆尔。晚发言者的平均成本是早发言者的两倍多（即18 448美元对18 448美元）。8455元）。晚现者年龄大、男性、黑人、有男男性行为（MSM）或异性性接触的危险性较高（P < 0.05）。然而，平均成本的巨大差异不能归因于特征的差异。当特征在统计学上保持不变时，延迟呈现的估计额外成本几乎不受影响，为9723美元（z = 5.6）。重复使用分类成本计算类别的分析表明，在总成本的差异主要是由于艾滋病毒相关的医院护理费用，这是15倍以上的晚presenters.Conclusions直接护理费用在一年后的艾滋病毒诊断的差异超过200%的患者谁提出晚。这种差异不能归因于患者特征的差异。大部分费用是与艾滋病毒有关的住院护理费用和立即开始抗逆转录病毒疗法。虽然对艾滋病毒高危人群进行早期诊断在医学上仍然很重要，但短期经济影响也很大。
Objective To compare the direct costs of medical care in the year following HIV diagnosis for patients who present with a CD4 count < 200 cells/muL ('late presenters') and those who present with a CD4 count > 200 cells/muL ('early presenters').Methods Direct costs (i.e. drugs, laboratory tests, outpatient care, in-patient care, and home care) for the 12 months following HIV diagnosis, sociodemographic data and clinical data were collected for all patients presenting for HIV care in Southern Alberta, Canada between April 1996 and April 2001. Mean costs are presented as costs in 2001 Canadian dollars.Results Thirty-nine per cent of 241 patients presented with a CD4 count < 200 cells/muL. The mean costs for late presenters were more than twice as high as those for early presenters (i.e. $18 448vs. $8455, respectively). Late presenters were more likely to be older, male and black, and to have a risk activity of men having sex with men (MSM) or heterosexual contact (P < 0.05). However, the large difference in mean costs cannot be attributed to differences in characteristics. When characteristics were statistically held constant, the estimated excess cost of late presentation was almost unaffected, at $9723 (z = 5.6). Repeating the analysis using disaggregated costing categories suggested that the difference in total costs was largely attributable to differences in HIV-related hospital care costs, which were 15 times higher for late presenters.Conclusions Direct care costs in the year following HIV diagnosis were more than 200% higher for patients who presented late. This difference could not be attributed to differences in patient characteristics. Most costs were attributable to HIV-related hospital care costs and the immediate initiation of antiretroviral therapy. While early diagnosis in those at risk for HIV remains medically important, the short-term economic impact is also substantial.