Costs to Medicaid of advancing immunosuppression in an urban HIV-infected patient population in Maryland.
Costs to Medicaid of advancing immunosuppression in an urban HIV-infected patient population in Maryland.
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马里兰州城市艾滋病毒感染者群体中推进免疫抑制的医疗补助费用。
DOI：
10.1097/00042560-199703010-00005
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Chaisson,RE
中科院分区：
文献类型：
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作者：
Moore,RD;Chaisson,RE
人类免疫缺陷病毒（HIV）感染日益成为美国的一种城市疾病，而医疗补助是艾滋病毒患者医疗保健费用的主要支付者。我们希望确定随着免疫抑制的进展，马里兰州感染艾滋病毒的患者的医疗补助费用，并确定费用如何根据患者的人口特征而变化。我们分析了约翰霍普金斯大学艾滋病毒服务中心患者的综合经济和临床数据，该服务中心为巴尔的摩大都市区的大多数艾滋病毒感染者提供初级和专业护理。所有患者均参加了医疗补助计划，并从 1992 年 7 月至 1995 年 6 月在马里兰州纵向接受护理。按性别、种族、年龄、注射药物的使用、CD4+ 计数（> 500、201-500、51-200、≤ 50 个细胞/mm 3）、几种机会性疾病和死亡情况计算所有住院和门诊服务的每月医疗补助付款。还通过使用马尔可夫模拟来计算生命周期成本。在对 606 名患者进行 13,174 人月的随访期间，总共支付了 18,223,700 美元的医疗补助费用。 CD4+ 计数≤ 50 个细胞/mm 3 的患者的平均每月付款范围为 2,436 美元（SE $171），CD4+ 计数> 500 个细胞/mm 3 的患者为 1,015 美元（SE $177）。CD4+ 计数≤ 50 个细胞/mm 3 的患者每月平均住院费用为 1,355 美元（SE $131）和 617 美元（SE $164）。对于 CD4+ 计数 > 500 个细胞/mm 3 的患者。对于 CD4+ 计数≤ 50 个细胞/mm 3 的患者，门诊药房费用平均每月 515 美元（SE 57 美元），仅次于住院费用。在双变量分析中，男性的成本（平均 1696 美元；SE 126 美元）显着高于女性（平均 1,208 美元；SE 101 美元）（p=.013），但多变量调整后差异并不显着。巨细胞病毒性视网膜炎是最昂贵的机会性疾病，诊断后 6 个月内平均每月费用为 7,825 美元（SE 1,141 美元）。死亡后 6 个月内，每月平均费用为 4,600 美元（424 瑞典克朗）。治疗 CD4+ 计数> 500 个细胞/mm 3 的 HIV 感染患者的终生费用为 8.3 年 133,500 美元。我们得出的结论是，在进行分析的诊所中，随着 CD4+ 计数从 > 500 个细胞/mm 3 下降到≤ 50 个细胞/mm 3 ，治疗患者的医疗补助平均费用增加了两倍以上。减少住院、机会性疾病和临终护理费用的干预措施最有可能降低总体费用。当获得护理的机会具有可比性时，患者的人口特征不会对成本产生显着影响。
Human immunodeficiency virus (HIV) infection is increasingly an urban disease in the United States, and Medicaid is the principal payer of the health care costs of patients with HIV. We wished to determine the costs to Medicaid of patients in Maryland infected with HIV as immunosuppression progresses, and to determine how costs varied by demographic characteristics of the patient. We analyzed combined economic and clinical data in patients from the Johns Hopkins HIV Service, the provider of primary and specialty care for a majority of HIV-infected patients in the Baltimore metropolitan region. All patients were enrolled in Medicaid and received care longitudinally in Maryland from July 1992 to June 1995. Monthly Medicaid payments were calculated for all inpatient and outpatient services by sex, race, age, use of injecting drugs, CD4+ count (> 500, 201-500, 51-200,≤ 50 cells/mm 3), several opportunistic diseases, and death. Lifetime costs were also calculated by use of a Markov simulation. During 13,174 person-months of follow-up in 606 patients, a total of $18,223,700 in Medicaid payments was made. Mean monthly payments ranged from $2,436 (SE $171) for patients with CD4+ counts≤ 50 cells/mm 3 to $1,015 (SE $177) for patients with CD4+ counts> 500 cells/mm 3. Mean monthly inpatient costs ranged from $1,355 (SE $131) for CD4+ counts≤ 50 cells/mm 3 and $617 (SE $164) for CD4+ counts> 500 cells/mm 3. For those with CD4+ counts≤ 50 cells/mm 3, outpatient pharmacy costs averaged $515 (SE $57) monthly, second only to inpatient costs. In bivariate analysis, costs were significantly higher (p=. 013) in men (mean $1696; SE $126) than in women (mean $1,208; SE $101), though the difference was not significant with multivariate adjustment. Cytomegalovirus retinitis was the most costly opportunistic disease, with mean monthly costs of $7,825 (SE $1,141) within the 6 mo after diagnosis. Within 6 mo of death, mean monthly costs are $4,600 (SE $424). Lifetime costs for treating an HIV-infected patient who presents with a CD4+ count> 500 cells/mm 3 are $133,500 over 8.3 years of life. We concluded that in the clinic where the analysis was done, average costs to Medicaid of treating patients increase more than two-fold as the CD4+ count declines from> 500 cells/mm 3 to≤ 50 cells/mm 3. Interventions that decrease hospitalization, opportunistic disease, and the costs of terminal care may be most likely to decrease overall costs. Demographic patient characteristics do not affect costs significantly when access to care is comparable.