Determinants of the Cost of Health Services Used by Veterans With HIV
Determinants of the Cost of Health Services Used by Veterans With HIV
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DOI：
10.1097/mlr.0b013e31821b34c0
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发表时间：
2011-09-01
期刊：
影响因子：
3
通讯作者：
Owens, Douglas K.
中科院分区：
文献类型：
--
作者：
Barnett, Paul G.;Chow, Adam;Owens, Douglas K.
背景：依从性、治疗失败和合并症对HIV护理成本的影响尚不清楚。目的：了解包括联合抗逆转录病毒治疗（ART）在内的艾滋病护理费用。研究设计：行政数据的观察性研究。受试者：在美国退伍军人健康管理局（VHA）随机选择的总共1896名HIV感染患者和288名耐多药HIV试验参与者。措施：合并症、费用、药房和实验室数据。结果：随机抽样中有24.5%的hiv感染者未接受抗逆转录病毒治疗。门诊药房费用占抗逆转录病毒治疗高依从性患者费用的62.8%，占依从性较低患者费用的32.2%，占未接受抗逆转录病毒治疗患者费用的6.2%。与未接受抗逆转录病毒治疗的患者相比，高依从性与较低的住院费用相关，但没有更高的总费用。CD4细胞计数低的个体(500。大多数患者有医学、精神或药物滥用的合并症。这些条件与更高的成本有关。与随机抽样的感染艾滋病毒的VHA患者相比，试验参与者患精神疾病和药物滥用合并症的可能性较小。结论：联合抗逆转录病毒治疗患者用药费用较高，但急性住院费用较低。艾滋病毒控制不佳与较高的费用有关。在艾滋病毒研究中经常被忽视的精神病学、药物滥用、康复、长期护理和抗逆转录病毒治疗以外的药物的费用是巨大的。
Background: The effect of adherence, treatment failure, and comorbidities on the cost of HIV care is not well understood.Objective: To characterize the cost of HIV care including combination antiretroviral treatment (ART).Research Design: Observational study of administrative data.Subjects: Total 1896 randomly selected HIV-infected patients and 288 trial participants with multidrug-resistant HIV seen at the US Veterans Health Administration (VHA).Measures: Comorbidities, cost, pharmacy, and laboratory data.Results: Many HIV-infected patients (24.5%) of the random sample did not receive ART. Outpatient pharmacy accounted for 62.8% of the costs of patients highly adherent with ART, 32.2% of the cost of those with lower adherence, and 6.2% of the cost of those not receiving ART. Compared with patients not receiving ART, high adherence was associated with lower hospital cost, but no greater total cost. Individuals with a low CD4 count (500. Most patients had medical, psychiatric, or substance abuse comorbidities. These conditions were associated with greater cost. Trial participants were less likely to have psychiatric and substance abuse comorbidities than the random sample of VHA patients with HIV.Conclusions: Patients receiving combination ART had higher medication costs but lower acute hospital cost. Poor control of HIV was associated with higher cost. The cost of psychiatric, substance abuse, rehabilitation, and long-term care and medications other than ART, often overlooked in HIV studies, was substantial.