The economic burden of late entry into medical care for patients with HIV infection.
The economic burden of late entry into medical care for patients with HIV infection.
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DOI：
10.1097/mlr.0b013e3181f81c4a
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发表时间：
2010-12
期刊：
影响因子：
3
通讯作者：
HIV Research Network
中科院分区：
文献类型：
--
作者：
Fleishman JA;Yehia BR;Moore RD;Gebo KA;HIV Research Network
很大一部分感染人类免疫缺陷病毒（艾滋病毒）的人在艾滋病毒病程后期才接受护理。晚入会增加护理支出。估计艾滋病病毒感染者在初次就诊时的直接医疗保健支出与疾病状况的关系。晚期进入定义为初始CD 4检测结果≤200个细胞/mm 3，中期进入定义为初始CD 4计数>200且≤500个细胞/mm 3;早期进入定义为初始CD 4计数>500。这项研究包括8348名接受艾滋病毒初级保健的患者，他们是2000年至2006年期间在参加艾滋病毒研究网络的10个艾滋病毒诊所之一新登记的。我们回顾了2000年至2007年的病历数据。我们估计了每次门诊和住院日的费用，以及每月的药物费用（抗逆转录病毒和机会性疾病预防）。我们将单位成本乘以利用率，以估计住院天数、门诊就诊、HIV药物和实验室检查的支出。我们分析了累积支出与初始CD 4计数之间的关系，并按护理年数分层。晚期患者占新患者的43.1%。入组后接受护理的年数在初始CD 4组之间没有显著差异。平均累计治疗费用范围从27，275美元到61，615美元不等，晚比早介绍者高。经过7到8年的护理，差异仍然很大。在艾滋病毒感染后期接受医疗护理的患者的直接医疗支出大大高于早期接受治疗的患者。在病程早期将患者与医疗护理联系起来的成功努力可能会节省费用。
A large proportion of people with human immunodeficiency virus (HIV) infection enter care late in the HIV disease course. Late entry can increase expenditures for care. To estimate direct medical care expenditures for HIV patients as a function of disease status at initial presentation to care. Late entry is defined as initial CD4 test result ≤200 cells/mm3, intermediate entry as initial CD4 counts >200, and ≤500 cells/mm3; and early entry as initial CD4 count >500. The study included 8348 patients who received HIV primary care and who were newly enrolled between 2000 and 2006 at one of 10 HIV clinics participating in the HIV Research Network. We reviewed medical record data from 2000 to 2007. We estimated costs per outpatient visit and inpatient day, and monthly medication costs (antiretroviral and opportunistic illness prophylaxis). We multiplied unit costs by utilization measures to estimate expenditures for inpatient days, outpatient visits, HIV medications, and laboratory tests. We analyzed the association between cumulative expenditures and initial CD4 count, stratified by years in care. Late entrants comprised 43.1% of new patients. The number of years receiving care after enrollment did not differ significantly across initial CD4 groups. Mean cumulative treatment expenditures ranged from $27,275 to $61,615 higher for late than early presenters. After 7 to 8 years in care, the difference was still substantial. Patients who enter medical care late in their HIV disease have substantially higher direct medical treatment expenditures than those who enter at earlier stages. Successful efforts to link patients with medical care earlier in the disease course may yield cost savings.